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Extracorporeal photopheresis is catching up the pole position

Bone Marrow Transplantation volume 56, pages 303–304 (2021)Cite this article

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Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic hematopoietic cell transplantation (HCT). In 1966, Billingham defined three criteria for the development of aGVHD: (1) immunocompetent cells in the graft must be present; (2) the host must appear foreign to the graft because of some disparity in important alloantigens and; (3) the host must be incapable of rejecting the graft. Today, we also know that autologous GVHD is possible because of inappropriate recognition of host self-antigen, and transfusion-associated GVHD (TA-GVHD) may develop in certain immunocompetent individuals [1].

When aGVHD is diagnosed, the mainstay of therapy is steroids. Topical, oral, or intravenous administration of steroids is determined by the severity of the disease and the degree of organ involvement. Whereas there is uncertainty as to whether grade I aGVHD should be treated or not, 2 mg/Kg/day of methylprednisolone, or an equivalent steroid, is the recommended initial dose for patients with grade II–IV aGVHD. Addition of other immunosuppressive agents has failed to find a beneficial effect in randomized controlled trials (RCT). In large retrospective reviews, 50% of patients do not respond to steroids therapy. For this group of patients, there is no accepted secondary therapy [2].

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Authors and Affiliations

  1. Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Joan Cid & Miquel Lozano

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  1. Joan Cid
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  2. Miquel Lozano
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Correspondence to Joan Cid.

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Cid, J., Lozano, M. Extracorporeal photopheresis is catching up the pole position. Bone Marrow Transplant 56, 303–304 (2021). https://doi.org/10.1038/s41409-020-01077-w

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