Photopheresis in pediatric graft‐versus‐host disease after allogeneic marrow transplantation: clinical practice guidelines based on field experience and review of the literature

Abstract

A specifically pediatric-dedicated and -experienced team faces only limited difficulties when treating children with GVHD by ECP. Overall, ECP is efficient and well tolerated. Our experience was therefore pooled together with available pediatric data to establish clinical practice guidelines. These guidelines consider ECP as a first-line therapy in Grade IV aGVHD (in association with conventional pharmacologic approaches) and limited cGVHD and as a second-line therapy in steroid-resistant Grades II to III aGVHD and extensive cGVHD.

The Role of Photopheresis in the Treatment of Graft-Versus-Host Disease

“…The experience in children is much more limited, but suggests that similar results can be obtained 15 . Therakos sponsored a prospective controlled trial of ecp in agvhd, planning to enrol 30 centres and to recruit about 120 patients per treatment arm.…”

“…The uv radiation is performed by an Uvamatic Irradiator (Vilber Lourmat, Marne-La-Vallée, France) at 2 J/cm 3 , after which the cells are re-infused. This procedure can therefore be used on children weighing as little as 13 kg 15 .…”

Extracorporeal photopheresis in 62 patients with acute and chronic GVHD: Results of treatment with the COBE Spectra System

“…Overall, complete and partial resolution of cutaneous manifestations in aGVHD were observed in a median of 75% (range: 50-100%), of hepatic involvement in a median of 47% (range: 0-100%) and of gastrointestinal manifestations in a median of 58% (range: 0-100%) of patients. 6,8,9,11,12,[22][23][24][25][26][27][28] In this retrospective analysis the response rate in aGVHD was 50% after 3 months. In our analysis patients receiving additional new IST during ECP were classified as 'nonresponders', which might be the reason for the lower response rates in aGVHD in our series of patients compared with published results reflecting the limitations of a retrospective analysis of the daily practice.…”

Bronchiolitis obliterans after allo-SCT: clinical criteria and treatment options

“…86 Though several studies have been performed in patients with BO after HSCT [61][62][63][64][65][87][88][89][90][91] and lung transplantation, [92][93][94] the studies are difficult to interpret because of the heterogeneity in the treatment schedules, diagnostic criteria and response assessment criteria (Table 1). A prospective randomised study of extracorporeal photopheresis treatment performed by Flowers et al 61 revealed a significant improvement of cGVHD in the skin, and indicated a steroid sparing effect on cGvHD in general.…”