Extracorporeal photopheresis in the treatment of acute graft-versus-host disease : a single-center experience

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http://hdl.handle.net/10138/305621

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Niittyvuopio , R , Juvonen , E , Heiskanen , J , Lindstrom , V , Nihtinen , A , Sahlstedt , L & Volin , L 2018 , ' Extracorporeal photopheresis in the treatment of acute graft-versus-host disease : a single-center experience ' , Transfusion , vol. 58 , no. 8 , pp. 1973-1979 . https://doi.org/10.1111/trf.14649

Titel: Extracorporeal photopheresis in the treatment of acute graft-versus-host disease : a single-center experience
Författare: Niittyvuopio, Riitta; Juvonen, Eeva; Heiskanen, Jouni; Lindstrom, Vesa; Nihtinen, Anne; Sahlstedt, Leila; Volin, Liisa
Upphovmannens organisation: Clinicum
Hematologian yksikkö
Department of Oncology
Department of Medicine
HUS Comprehensive Cancer Center
HUS Internal Medicine and Rehabilitation
Datum: 2018-08
Språk: eng
Sidantal: 7
Tillhör serie: Transfusion
ISSN: 0041-1132
DOI: https://doi.org/10.1111/trf.14649
Permanenta länken (URI): http://hdl.handle.net/10138/305621
Abstrakt: BACKGROUND: Steroid-refractory acute graft-versushost disease (aGVHD) is a serious complication after hematopoietic stem cell transplantation. The long-term outcome of the patients is poor. Various immunosuppressive agents have been proposed as the second-line therapy but none of them has turned out more effective than the others. Extracorporeal photopheresis (ECP) is a treatment option that does not predispose the patients to severe side effects of the immunosuppressive drugs. STUDY DESIGN AND METHODS: We analyzed the treatment results of ECP in 52 patients with steroidrefractory or steroid-dependent aGVHD. Eighty-one percent of the patients suffered from a severe, Grade III or IV, aGVHD. ECP was started alone as the second-line treatment in 23 patients and in combination with an immunosuppressive drug in 18 patients. Eleven patients received ECP as the third-line or later treatment. RESULTS: A total of 62% of the patients responded, with 48% achieving complete response. In the patients with complete or partial response, the probabilities of survival at 4 years were 54 and 17%, respectively. The outcome of nonresponders was poor. The 1-year overall survivals of the patients with ECP as the second-line treatment either alone or in combination with an immunosuppressive drug or as the third-line treatment were 51, 28, and 18%, respectively. In multivariate analysis, starting ECP no later than 10 days after the start of the first-line treatment correlated with a good response and a consequent survival benefit. CONCLUSION: Extracorporeal photopheresis is an effective and well-tolerated treatment that should be considered as a second-line treatment for aGVHD.
Subject: REFRACTORY ACUTE GVHD
BONE-MARROW-TRANSPLANTATION
2ND-LINE TREATMENT
PEDIATRIC-PATIENTS
CLINICAL-EFFICACY
DENDRITIC CELLS
ITALIAN GROUP
PHOTOCHEMOTHERAPY
SURVIVAL
RECOMMENDATIONS
3121 General medicine, internal medicine and other clinical medicine
3122 Cancers
Referentgranskad: Ja
Licens: unspecified
Användningsbegränsning: openAccess
Parallelpublicerad version: publishedVersion


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