eISSN: 1644-4124
ISSN: 1426-3912
Central European Journal of Immunology
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1/2019
vol. 44
 
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abstract:
Clinical immunology

Higher response rates in patients with severe chronic skin graft-versus-host disease treated with extracorporeal photopheresis

Gabriel Afram
1, 2
,
Emma Watz
3, 4
,
Mats Remberger
5, 6
,
Ulla Axdorph Nygell
1, 3, 4
,
Mikael Sundin
7, 8
,
Hans Hägglund
9
,
Jonas Mattsson
5, 6
,
Michael Uhlin
3, 4

  1. Hematology Centre, Karolinska University Laboratory, Stockholm, Sweden
  2. Division of Hematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  3. Department of Clinical Immunology and Transfusion Medicine, Karolinska University Laboratory, Stockholm, Sweden
  4. Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden
  5. Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
  6. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
  7. Hematology/Immunology/SCT Section, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
  8. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  9. Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
(Centr Eur J Immunol 2019; 44 (1): 84-91)
DOI: https://doi.org/10.5114/ceji.2018.75831
Online publish date: 2019/04/15
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Introduction
Different forms of graft-versus-host disease (GVHD) remain a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). The prognosis for steroid-refractory chronic GVHD (cGVHD) remains poor. Our aim was to evaluate extracorporeal photopheresis (ECP) treatment in cGVHD patients with different organ involvement to detect subgroups of patients with the best response.

Material and methods
Thirty-four patients who underwent HSCT and developed moderate (n = 7) or severe (n = 27) steroid-refractory or steroid-dependent cGVHD treated with ECP were included in the analysis. A matched cGVHD control patient group untreated with ECP was collected for comparison.

Results
Compared to the control group and the stable/progressive disease (SD/PD) patients, individuals with complete/partial remission have higher overall survival and lower transplant-related mortality. Furthermore, patients with complete and partial remission (CR/PR) had significantly higher levels of albumin and platelets after ECP treatment compared to patients with stable or progressive cGVHD (SD/PD). Corticosteroid treatment and other immunosuppressive agents could successfully be tapered in the CR/PR group compared to the SD/PD patients. In this study patients with skin cGVHD are those with the highest rate of CR/PR after ECP treatment.

Conclusions
Our results suggest that ECP treatment is safe and effective for patients with predomi­nantly skin, oral and liver cGVHD.

keywords:

ECP, cGVHD, treatment
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