Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD

Abstract

Extracorporeal photopheresis (ECP) has become a recognised treatment for steroid-refractory chronic GVHD (cGVHD), but the optimal frequency and duration of treatment are yet to be established. We report on 82 consecutive patients with mucocutaneous cGVHD who received a bimonthly regimen of ECP treatment for two consecutive days, which could be subsequently tapered to a monthly regimen depending on response. Patients were steroid-refractory, steroid-dependent or steroid-intolerant, and 29 (35%) had multiorgan involvement. The median duration of treatment was 330 days (42-987). The median number of ECP cycles was 15 (1.5-32). Response was assessed by clinical assessment and reduction in immunosuppression after 6 months. 69/82 (84%) had completed 6 months of ECP and 65/69 (94%) had X50% improvement in symptoms and signs of cGVHD. A total of 77% of patients who completed 6 months of ECP had a reduction in immunosuppression dose and 80% had decreased their steroid dose (27.5% stopped, 30% had X75% reduction, 17.5% had X50% reduction and 25% had o50% reduction). OS at 3 years from the start of ECP was 69%. This study reports the largest series of patients receiving bimonthly ECP treatment for cGVHD, and confirms that ECP allows successful reduction of immunosuppression.

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

“…The results are remarkably consistent with the retrospective study we have reported previously. 2 The earlier study showed that 77% of patients who completed 6 months of ECP treatment had a reduction in immunosuppression, and the prospective study showed that 80% of patients who completed 6 months of ECP had a reduction in immunosuppression. One limitation of this study was the number of patients who did not complete 6 months of treatment (11/38, 29% of patients).…”

“…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.…”

“…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.…”

State-of-the-art acute and chronic GVHD treatment

“…Other retrospective studies have shown benefit of ECP in treatment of cGVHD as well [106,128]. A study of 80 patients receiving two consecutive ECP treatments every 2 weeks showed that 84 % patients were able to complete 6 months of treatment and 50 % patients had reduction in symptoms [129], thus suggesting this probably is an effective regimen. Some biomarkers were proposed which may predict the response to ECP.…”

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

“…6 ECP is effective in the treatment of both steroid-refractory and -dependent aGVHD and cGVHD. [7][8][9][10][11][12] Here, we report a retrospective analysis of 62 patients with aGVHD and cGVHD treated with ECP employing the COBE Spectra System. The aim was to assess possible factors influencing response to ECP and survival such as patients' clinical features, concomitant immunosuppressive treatment, and GVHD characteristics.…”