Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response

Abstract

We report 28 patients with advanced chronic graft-versus-host disease (cGVHD) treated with extracorporeal photopheresis (ECP). All had failed conventional immunosuppressive therapy. Of the patients, 27 had extensive cGVHD and 20 had more than 50% cutaneous surface area involvement. ECP was initiated approximately 2 years after onset of cGVHD and 3 years following allogeneic stem cell transplantation and administered fortnightly for 4 months and then monthly. Response was assessed using quantifiable disease measures, including skin score, liver function tests (LFTs), blood counts, and lung function tests. Regression analysis allowed assessment of any pretreatment clinical or laboratory parameters that predicted response. There were 25 patients who completed 3 months and 21 who completed 6 months of treatment. Systemic immunosuppression was stable or reduced in 86% of patients. There were 3 patients who died from cGVHD. After 6 months, median skin scores were 53% lower (P ‫؍‬ .003) in sclerodermoid and lichenoid disease. Of 6 patients with mucosal ulceration, 3 im-

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

“…Previous reports have used a variety of schedules and have not reported the effect on QoL using validated questionnaires. [6][7][8][9][10] This is the first prospective study to investigate the effect of a fortnightly schedule of ECP on clinical response and QoL in cGVHD using two validated questionnaires. This report benefits from a standardised regimen of ECP, prospective data accrual, lack of inter-observer variation and stringent use of NIH criteria.…”

“…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.…”

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

“…3,4 Despite its clinical effectiveness, the immunomodulatory mechanisms of ECP are not fully understood. 5 Previous studies proposed triggering of lymphocyte, monocyte and natural killer cell apoptosis, 6 the induction of regulatory T cells (Tregs), [7][8][9] including enhancement of Treg function, 10 modulation of pro-inflammatory cytokines and/ or induction of tolerogenic dendritic cells [11][12][13][14] as potential modes of ECP action.…”

Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD

“…Promising multiorgan responses have been reported in patients with cGVHD in several non-randomised, nonblinded studies. [13][14][15][16][17][18][19][20][21][22][23] Flowers et al 24 have recently published the first multicentre, randomised controlled, prospective phase II trial of ECP in the treatment of patients with cGVHD. The study used percentage improvement in total skin scores after 12 weeks of ECP treatment as the primary endpoint.…”