Transplantation 2016 Dec;100(12):e147-e155
1 Hematology, Bone Marrow Transplantation Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy. 2 Immunohematology and Transfusion Medicine Unit, AO Spedali Cvili, Brescia, Italy. 3 SODc Terapia Cellulare e Medicina Trasfusionale, AOU Careggi, Firenze, Italy. 4 Divisione di Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 5 SC Ematologia, Istituto Nazionale Tumori, Milano, Italy. 6 Clinica Ematologica e Unità di terapie Cellulari, DISM, Università di Udine, Italy. 7 Centro di Ricerca Emato-oncologica AIL (CREA) Brescia, AO Spedali Civili di Brescia, Italy. 8 Unità di Cellule Staminali, Istituto Europeo di Oncologia, Milano, Italy. 9 Medicina Trasfusionale, Azienda Ospedaliero-Universitaria di Udine, Italy. 10 UO di Emotrasfusione, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 11 Bone Marrow Transplant Unit SODc Ematologia, AOU Careggi, Firenze, Italy.
Background: Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD).
Methods: Ninety-four patients with acute GVHD (aGVHD) (n = 45) and chronic GVHD (cGVHD) (n = 49), retrospectively recruited in 6 Italian centers, were submitted to ECP for second-line treatment. At the time of ECP, 22 (49%) and 23 (51%) of 45 patients with aGHVD were nonresponsive and in partial remission (PR) after steroids, respectively, and all the 49 patients with cGVHD were steroid refractory.
Results: Forty-one (91%) of 45 patients with aGVHD achieved complete remission (CR) after ECP. Fifteen (33%) of 45 patients developed cGVHD. The CR rate in patients who started ECP being nonresponsive and in PR after steroid was 86% and 96%, respectively. After a median follow-up of 20 months (range, 2-72), 15 (33%) of 45 patients developed cGHVD and 16 (35%) of 45 patients died, in 3 cases for aGVHD. A trend for a better survival was seen among patients who started ECP in PR after steroid (80% vs 50% at 2 years; P = 0.07). Overall, 22 (45%) of 49 patients and 17 (35%) of 49 patients with steroid refractory cGHVD achieved CR and PR after ECP, respectively. After a median follow-up of 27 months, 44 (90%) of 49 patients are alive, 21 of whom (48%) are on steroid.
Conclusions: Extracorporeal photopheresis is confirmed as an effective second-line treatment in both aGVHD and cGVHD, because it can induce a response in more than 80% of the patients and a long-term survival in at least 50% of the cases.