Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD

Couriel, Daniel R.; Hosing, Chitra; Saliba, Rima M.; Shpall, Elizabeth J.; Anderlini, Paolo; Rhodes, Buck A.; Smith, Veronica; Khouri, Issa F.; Giralt, Sergío; Lima, Marcos de; Hsu, Yvonne; Ghosh, S.; Neumann, Joyce; Andersson, Börje S.; Qazilbash, Muzaffar H.; Hymes, Sharon R.; Kim, Stella; Champlin, Richard E.; Donato, Michèle

doi:10.1182/blood-2005-09-3907

Cited by 246 publications

(228 citation statements)

References 28 publications

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“…Patients with stable or progressive disease were considered as nonresponders (NR). 11,12 Viral reactivations were detected by PCR positivity for EBV-DNA (cutoff: 300 copies) and CMV-DNA (cutoff: 300 copies). Patients underwent clinical assessment at the baseline and after 3, 6, 12, 18 and 24 months.…”

Section: Gvhd Response Criteriamentioning

confidence: 99%

Extracorporeal photochemotherapy may improve outcome in children with acute GVHD

Calore

Caló

Tridello

et al. 2008

Bone Marrow Transplant

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Acute GVHD (aGVHD) is a major cause of morbidity and mortality after unrelated BMT (UBMT). Our purpose was to analyze the role of extracorporeal photochemotherapy (ECP) in controlling grade II-IV aGVHD in children given UBMT. Of 41 consecutive children, 31 developed grade II-IV aGVHD after UBMT: 16 had a good response to steroids (GR group), whereas 15 underwent ECP (ECP group) within 100 days of UBMT. Eligibility criteria for starting ECP were steroid resistance, dependence or viral reactivations. Criteria for judging response to aGVHD treatment were that the resolution of all signs were considered a complete response (CR), at least a 50% improvement was classified as a partial response (PR) and stable or progressive disease was judged as no response (NR). On completing ECP, the CR rate was 73%, whereas the GR group had a CR rate of 56% by day 100. The 2-year overall survival and progression-free survival rates were 57 and 67% in the GR group vs 85 and 87% in the ECP group. Our data seem to suggest that ECP may improve outcome in patients after UBMT. These findings need to be confirmed in a larger population.

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Section: Gvhd Response Criteriamentioning

confidence: 99%

Extracorporeal photochemotherapy may improve outcome in children with acute GVHD

Calore

Caló

Tridello

et al. 2008

Bone Marrow Transplant

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“…Our group and others have previously reported the efficacy of ECP in the management of cGVHD in retrospective studies. [2][3][4][5] To date, there are only a few prospective studies of ECP for this condition [6][7][8][9] and one randomised prospective trial. 10 In addition, there are few data on the effect of ECP on quality of life (QoL) in patients with cGVHD.…”

Section: Introductionmentioning

confidence: 99%

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Dignan

Aguilar

Scarisbrick

et al. 2014

Bone Marrow Transplant

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There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients' quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P ¼ 0.012 and 3.4 compared with 6.9, P ¼ 0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD. Our group and others have previously reported the efficacy of ECP in the management of cGVHD in retrospective studies. [2][3][4][5] To date, there are only a few prospective studies of ECP for this condition 6-9 and one randomised prospective trial. 10 In addition, there are few data on the effect of ECP on quality of life (QoL) in patients with cGVHD.In a retrospective study, we have previously shown that a fortnightly regimen of ECP improved the clinical signs and symptoms of cGVHD. 2 The aim of the current report was to prospectively assess the effect of a fortnightly schedule of ECP on the clinical signs and symptoms of cGVHD. The secondary aims were to assess the effect of ECP on health-related QoL and to assess response in terms of change in immunosuppression dose at 6 months.

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“…If new lesions occur >3 years post-transplant, secondary malignancy should be excluded with biopsy. The lesion often starts as leukoplakia and can be confused with cGvHD but may be a squamous cell carcinoma (SCC) (Couriel et al 2006b). …”

Section: Chronic Gvhd Of the Oral Cavitymentioning

confidence: 99%

“…Typically occurring in the first 12 months, it can be seen as early as 2 months and as late at 7 years at onset, although onset at >1 year from transplant occurs in <10% of cases . The risk of infection due to the delay in immune reconstitution and use of immunosuppressive therapies to treat cGvHD remains, however, the leading cause for death in this group of patients (Couriel et al 2006b). Supportive care advances have decreased the morbidity, but survival has not changed significantly since the 1980s.…”

Section: Chronic Graft-versus-host Diseasementioning

confidence: 99%

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Graft-Versus-Host Disease (GvHD)

Murray

Stringer

Hutt

2017

The European Blood and Marrow Transplantation Textbook for Nurses

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Acute and chronic graft-versus-host disease (GvHD) is a major cause of morbidity and mortality in patients who undergo allogeneic haematopoietic cell transplantation (HCT) and affects approximately 30-40% of recipients. Its diagnosis is complicated, and staging of the disease varies dependent upon the transplant centre involved. Standardisation through the use of National Institute of Health (NIH) guidelines helps clinicians diagnose and treat their patients more effectively. For the majority of patients who go on to develop GvHD, corticosteroids remain the first-line treatment for both acute and chronic GvHD. Recipients that are refractory to systemic steroids have a plethora of second-and third-line options available to them. A 'standard of care' approach has not yet become agreed globally due to poor evidence from small and limited randomised control trials. Supportive care is paramount, and the nurse is often at the centre of the patients care and in the best position to guide and advise the patient and family through this often long-term complication.

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Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD

Cited by 246 publications

References 28 publications

Extracorporeal photochemotherapy may improve outcome in children with acute GVHD

Extracorporeal photochemotherapy may improve outcome in children with acute GVHD

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Graft-Versus-Host Disease (GvHD)

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