1. Extracorporeal photopheresis as first-line strategy in the treatment of acute graft-versus-host disease after hematopoietic stem cell transplantation: A single-center experience.
- Author
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Sestili S, Eder S, Belhocine R, Dulery R, Battipaglia G, Brissot E, Mediavilla C, Banet A, van de Wyngaert Z, Paviglianiti A, Ledraa T, Bonin A, Mohty M, and Malard F
- Subjects
- Acute Disease, Adult, Aged, Chronic Disease, Female, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Remission Induction, Retrospective Studies, Survival Analysis, Transplantation, Homologous adverse effects, Treatment Outcome, Young Adult, Graft vs Host Disease therapy, Hematopoietic Stem Cell Transplantation adverse effects, Photopheresis adverse effects
- 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., Competing Interests: Declaration of Competing Interest MM and FM received honoraria for lectures from Therakos/Mallinckrodt, whose device was included in this study. The other authors have no commercial, proprietary, or financial interest in the products or companies described in this article., (Copyright © 2020 International Society for Cell and Gene Therapy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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