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Shortened apheresis-based extra-corporeal photochemotherapy for acute refractory GVHD in children: a prospective study

Bone Marrow Transplantation volume 51, pages 866–868 (2016)Cite this article

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Extra-corporeal photochemotherapy (ECP) has been used for many years for the treatment of steroid-refractory acute GVHD (aGVHD). The American Society for Apheresis reported an overall response rate ranging from 52 to 100%.1 In children, this relies only on retrospective studies, whose interpretation is made difficult by poorly mastered indications, and variable schedules and durations of ECP sessions.2, 3, 4 ECP is a burdensome therapy due to the need to perform repeated aphereses. Some authors recently reported an efficacious technique of low-dose ECP, suggesting that a very large number of treated cells is not necessary in a setting of aGVHD.5 Here we report the first prospective study focusing on refractory aGVHD in pediatric patients, with a standard schedule but reduced apheresis duration (clinical trials: NCT 008 24 954).

We included patients aged 0–18 years, suffering from refractory aGVHD post allograft, weighing ⩾10 kg and not previously treated with an antilymphoglobulin (with the exception of graft conditioning). ECP was considered after 48 h of progressive aGVHD from the time of onset of steroid therapy, or non-regression after 7 days of steroid therapy and/or non-regression after a second-line treatment administered after at least 14 days. After the initiation, only the preventive treatment for the GVHD and the corticosteroids were given (apart from topical treatments). The decrease in the corticosteroids was left to the clinician’s discretion. All the patients received 6 sessions in 2 weeks. After 2 weeks, the schedule of ECP was 1 session per week for complete responders, and 2 sessions per week for partial responders, until the decrease in corticosteroids reached 0.5 mg/kg/day. ECP was then abruptly ceased. For patients in failure, the choice of treatment was left to the clinician. Both techniques (on-line or off-line6) for ECP could be used, depending on the center’s equipment. For children weighing <20 kg, the off-line treatment Macogenic technique was systematically preferred. The apheresis duration did not exceed 90 min or 1.5 blood volume processed.

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Authors and Affiliations

  1. CHU Clermont-Ferrand, Service d’Hématologie et Oncologie Pédiatrique, et Centre de Biothérapie d’Auvergne, Clermont-Ferrand, France

    A Sauret, N Rabiau, E Rochette, V Grèze, P Halle, J Kanold & E Merlin

  2. INSERM CIC 1405, Clermont-Ferrand, France

    A Sauret, N Rabiau, E Rochette, J Kanold & E Merlin

  3. Hôpital Robert-Debré, Service d′Hématologie, Paris, France

    M Ouachée, J-H Dalle, E Seror, D Serraz & K Yakouben

  4. CHU Grenoble, Service de Pédiatrie, La Tronche, France

    D Adjaoud & A Pagnier

  5. CHU Rouen, Service d′Immuno-Hémato-Oncologie Pédiatrique, Rouen, France

    A Marie-Cardine-Bobbia

  6. CHU Limoges, Service de Pédiatrie, Limoges, France

    C Oudot

  7. Hôpital de la Timone, Service de Pédiatrie et d′Hématologie, Marseille, France

    C Curtillet

  8. CHU de Nice, Service d′Hémato-oncologie pédiatrique, Nice, France

    M Poirée

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  1. A Sauret
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Correspondence to E Merlin.

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Sauret, A., Rabiau, N., Rochette, E. et al. Shortened apheresis-based extra-corporeal photochemotherapy for acute refractory GVHD in children: a prospective study. Bone Marrow Transplant 51, 866–868 (2016). https://doi.org/10.1038/bmt.2016.11

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