Treating refractory chronic graft-versus-host disease with extracorporeal photochemotherapy

Bisaccia, Emil; Palangio, Mark; Gonzalez, J.R. Flores; Adler, Kenneth R.; Rowley, Scott D.; Goldberg, SL

doi:10.1038/sj.bmt.1703830

Cited by 26 publications

(25 citation statements)

References 16 publications

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“…Among them, 6 were treated with ECP for <2 months (recurrence of primary disease [n = 4], new patient [n = 2]), leaving 14 evaluable patients (Table I). Preliminary data on 6 of these patients were previously reported [11]. The median age was 51.5 years (range, 25-57 years).…”

Section: Patient Characteristicsmentioning

confidence: 98%

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Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy

et al. 2006

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Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy developed for cutaneous T-cell lymphoma, has shown promise in treating chronic graft-versus-host disease (cGvHD) in uncontrolled studies. The purpose of this study was to further examine the effects of ECP on cGvHD. ECP (administered initially 3 times weekly on alternating days) was retrospectively evaluated in 14 patients with extensive cGvHD following allogeneic hematopoietic stem cell transplantation. The median time from transplantation to ECP initiation was 29 months (range, 5-96 months). The median number of concomitant baseline treatments per patient was 3 (range, 0-5). During a median ECP duration of 17 months (range, 3-44 months), 3 patients (21%) achieved a complete cutaneous response (100% improvement), 4 patients (29%) achieved a partial cutaneous response (> or =50% improvement), and 7 patients (50%) had stable skin disease. The median time to response was 6 months (range, 2-15 months), and the median response duration was 5 months (range, 1-31 months). At endpoint, responses were ongoing in 4 patients. Resolution or improvement was noted in arthralgia (5/7 patients), oral changes (3/7), elevated liver enzymes (3/5), dry eyes (2/5), joint stiffness (3/3), pulmonary disease (1/3), and thrombocytopenia (1/1). Because of a favorable response, 11 of 13 patients (85%) who received prednisone at baseline were able to taper (7/13; 54%) or discontinue (4/13; 31%) this medication, and 12 of 14 patients (86%) were able to taper (11/14; 79%) or discontinue (1/14; 7%) ECP. Five-year posttransplantation survival was 77%. Our results suggest that adjunctive ECP improves cutaneous and extracutaneous manifestations of cGvHD and has a steroid-sparing effect.

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Section: Patient Characteristicsmentioning

confidence: 98%

“…More than a decade of clinical experience has shown ECP to be well tolerated, with no evidence of general immunosuppression, making it an attractive option for patients with cGvHD. Expanding upon our previously published findings [11], we describe our experience using ECP in treating patients with extensive cGvHD.…”

Section: Introductionmentioning

confidence: 96%

Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy

et al. 2006

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“…Corticosteroids are still the first-line drugs used for GVHD, such as Methylprednisolone associated or not with Cyclosporine (Bisaccia et al, 2003). They are inflammatory mediators and useful as prophylactic treatment (Akpek et al, 2001), they act by preventing healthy tissues from responding to inflammatory processes, and inhibiting the release of inflammatory chemical mediators, making patients less susceptible to manifestations of GVHD.…”

Section: Discussionmentioning

confidence: 99%

“…It can prevent longterm complications when associated with steroids, and reduces the response-time to treatment (Bisaccia et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Local phototherapy (first month: 2 consecutive applications every week, total 8 applications + 2 consecutive applications every week 2 or 4 weeks) (Picardi et al, 2010) Not reported Local phototherapy (2 consecutive days with 2 weeks interval for 3 months + once every 4 weeks up to recovery) (Bisaccia et al, 2003) Open label single arm 15 (11 Buccal)…”

Section: Main Complicationsmentioning

confidence: 99%

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<b>Treatments and supportive therapies for oral manifestations of chronic graft-versus-host disease

Maiolino

Yamashita

Iwaki

et al. 2016

Acta Sci. Health Sci.

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ABSTRACT. The aim of this study was to conduct a systematic review of treatments and therapies for oral manifestations of chronic graft-versus-host disease, aiming at improving patients' quality of life and mainly the reduction of mortality caused by graft-versus-host disease. A systematic review was carried out by two evaluators, a Dentistry professor and an undergraduate student. A selection of open-access full-text online articles, carried out on PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS, and Web of Science. The survey was completed in July 2012. Of the 1147 studies found, 52 fit the selection criteria. Patients (n = 2130) received different treatment regimens, either systemic or topical. Drugs for systemic therapy were divided into those with action on the inhibition of proliferation and/or release of T and B cells, with action on inflammatory disorders, and of immunomodulatory effect. Topical drugs were divided into their pattern of mucosal absorption and their ability to act on tissue growth factors. The analysis of articles concluded that the most used systemic drugs were Methylprednisolone and corticosteroids, and Tacrolimus and topical Cyclosporine for topical and local therapy.Keywords: bone marrow transplantation. graft-vs-host disease.Tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro RESUMO. O objetivo do trabalho foi realizar uma revisão sistemática sobre tratamentos e terapias de suporte para manifestações orais da doença crônica do enxerto contra hospedeiro, visando à melhoria da qualidade de vida dos pacientes e, principalmente, a redução da mortalidade causada pela doença do enxerto contra hospedeiro. A revisão sistemática foi realizada por dois examinadores, um professor e um graduando de odontologia. A seleção de acesso aberto de artigos online de texto completo, realizadas no PubMed, GoPubmed, NLM Gateway, LILACS, BIREME, SciELO, IBECS e Web of Service. A revisão foi concluída em julho de 2012. Dos 1.147 estudos encontrados, 52 se enquadraram nos critérios de seleção. Os pacientes (n = 2130) receberam diferentes tratamentos, seja de forma sistêmica ou tópica. Os medicamentos para tratamento sistêmico foram divididos entre aqueles com ação na inibição da proliferação e / ou liberação de células T e B, com ação em doenças inflamatórias, e de efeito imunomodulador. Drogas tópicas foram divididas em seu padrão de absorção da mucosa e a sua capacidade para atuar sobre os fatores de crescimento de tecidos. A análise dos artigos permitiu concluir que os medicamentos sistêmicos mais utilizados foram Metilprednisolona e corticosteróides, e Tacrolimus e Ciclosporina tópica para a terapia tópica e local.Palavras-chave: transplante de medula óssea. doença enxerto-hospedeiro.

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

Schwartz

Winters

Padmanabhan

et al. 2013

J of Clinical Apheresis

560

769

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The American Society for Apheresis (ASFA) JCA Special Issue Writing Committee is charged with reviewing, updating and categorizating indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Sixth Edition of the ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by consistently applying the category and GRADE system definitions, but eliminating the "level of evidence" criteria (from the University HealthCare Consortium) utilized in prior editions given redundancy between GRADE and University HealthCare Consortium systems. The general layout and concept of a fact sheet that was utilized in the Fourth and Fifth Editions, has been largely maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. This article consists of 78 fact sheets (increased from 2010) for therapeutic indications in ASFA categories I through IV, with many diseases categorized having multiple clinical presentations/situations which are individually graded and categorized.

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Treating refractory chronic graft-versus-host disease with extracorporeal photochemotherapy

Cited by 26 publications

References 16 publications

Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy

Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy

<b>Treatments and supportive therapies for oral manifestations of chronic graft-versus-host disease

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue

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