Extracorporeal photopheresis as first-line strategy in the treatment of acute graft-versus-host disease after hematopoietic stem cell transplantation: A single-center experience.

Abstract

BACKGROUND AIMS:

Corticosteroids are the standard first-line treatment for acute graft-versus-host disease (aGVHD), but they are associated with many complications, and less than half of patients have a sustained response.

METHODS:

To improve outcomes, we performed a retrospective study to analyze the efficacy of the addition of extracorporeal photopheresis (ECP) to low-dose corticosteroids in 37 adult patients (median age, 57 years) with skin-predominant aGVHD (grade I, n = 17; grade II, n = 18; and grade III, n = 2). All patients received ECP in combination with 1 mg/kg prednisone (n = 26) or topical steroids (n = 11).

RESULTS:

Overall response rate was 81% after a median of three ECP procedures (range, 2-8), including 22 complete responses (CR, 59%) and eight very good partial responses (VGPR, 22%). The 11 patients treated with topical corticosteroids achieved CR. Furthermore, 16 (62%) patients reached prednisone withdrawal at a median of 100 days (range, 42-174 days) after its initiation. Eighteen patients developed chronic GVHD (cGVHD); 11 of them (who were in CR of aGVHD) had a new-onset cGVHD, and seven experienced progressive cGVHD (five non-responding and two VGPR patients). A second-line immunosuppressive treatment was initiated in only five (14%) non-responding patients. With a median follow-up of 31 months (range, 6-57 months) 2-year overall survival and non-relapse mortality were 74% and 11%, respectively.

CONCLUSIONS:

Overall, the combination of low-dose corticosteroids and ECP appear to be safe and effective for first-line treatment of skin predominant aGVHD.

• Authors: Simona Sestili, Sandra Eder, Ramdane Belhocine, Remy Dulery, Giorgia Battipaglia, Eolia Brissot, Clemence Mediavilla, Anne Banet, Zoe van de Wyngaert, Annalisa Paviglianiti, Tounes Ledraa, Agnes Bonin, Mohamad Mohty, Florent Malard
• Journal: Cytotherapy (Cytotherapy) Vol. 22 Issue 8 Pg. 445-449 (08 2020) ISSN: 1477-2566 [Electronic] England
• PMID: 32434750 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 International Society for Cell and Gene Therapy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Immunosuppressive Agents

Topics

• Acute Disease
• Adult
• Aged
• Chronic Disease
• Female
• Graft vs Host Disease (therapy)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Photopheresis (adverse effects)
• Remission Induction
• Retrospective Studies
• Survival Analysis
• Transplantation, Homologous (adverse effects)
• Treatment Outcome
• Young Adult