Update on extracorporeal photochemotherapy for graft-versus-host disease treatment

Abstract

Summary:Pediatric experience with extracorporeal photochemotherapy (ECP) for graft-versus-host disease (GvHD) has mainly been reported by Italian and French groups. Data concerning 41 children with acute GvHD and 63 children affected by chronic GvHD are available. In 73 and 63% of them, respectively, improvement was observed, with addition of ECP to their immunosuppressive regimen. Treatment with ECP was associated with minimal side effects, even in the smallest of patients. In all responded pediatric patients, both with acute and chronic GvHD, ECP allowed progressive reduction or discontinuation of the concomitant pharmacological immunosuppressive therapy without an increase in GvHD acitivity. These data show that ECP is a useful therapy for children affected by GvHD resistant to conventional treatment and can be safely used. Bone Marrow Transplantation (2005) 35, S69-S71.

The Italian registry of pediatric therapeutic apheresis: A report on activity during 2005

“…Mainly used for immunomodulation in graft-versus-host disease (GvHD) treatment [26], it is also used in children, albeit more rarely, even when there is solid organ (mainly kidney) transplantation rejection [27].…”

The use of fluid boluses to safely perform extracorporeal photopheresis (ECP) in low‐weight children: A novel procedure

“…Finally, the cells were returned to the patient. Since that time, several groups have successfully utilized this procedure in low-weight patients [16,[27][28][29][30][31][32][33][34][35]. Duzovali and Chan [36] reported data on 133 procedures performed on seven patients with steroid resistant cGVHD using the UVAR-XTS device.…”

“…Flowers et al [41] recently published results from the first randomized study comparing the response of skin disease in adults with steroid resistant cGVHD treated with standard therapy or standard therapy plus ECP. A statistically significant portion of the patients treated with standard therapy plus ECP had at least 50% reduction in steroid dose with at least 25% [30] 23 N COBE aGVHD 7/9 patients, cGVHD 1/14 patients Kanold [31] 102 N COBE (n 5 69), UVAR (n 5 33) Increased with aGVHD Messina [29] 77 N COBE in all but 1 clinical site Hgb < 12 (if < 15 Kg), all patients with aGVHD Calore [32] 15 Y COBE Hgb < 12 (if < 15 Kg) Kanold [28] 27 N COBE aGVHD 16%, cGVHD 7%, < 25 Kg 16%, > 25 Kg 8% Berger [34] 25 improvement in skin score. This could prove to be the single most important achievement of ECP, as steroids, calcineurin inhibitors, and monoclonal antibodies have not provided adequate control of GVHD while they cause potentially significant toxicity and susceptibility to bacterial, fungal, and viral infections.…”

Mononuclear cell collection in patients treated with extracorporeal photochemotherapy by using the off‐line method: A comparison between COBE Spectra AutoPbsc version 6.1 and Amicus cell separators

“…ECP treatment has been increasingly used as a potentially effective therapy in patients with cutaneous T-cell lymphoma [1], several dermatological diseases, organ rejection, autoimmune diseases [2,3], and acute or chronic GvHD following hematopoietic stem cell transplantation unresponsive to conventional treatment [9,10]. In the meanwhile, some of the putative mechanisms of action of ECP have been at least partially elucidated, underlining the possible role of CD41CD251Foxp3 T regulatory cell in restoring immunological tolerance [11][12][13].…”