Extracorporeal photopheresis for graft‐versus‐host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome—results from a large single‐center study

• DOI: 10.1111/trf.12900
• Publication Date: 2014-10-30T03:54:17Z
• Authors: Massimo Berger; Roberto Albiani; Bruno Sini; Franca Fagioli
• Keywords: Adult; Male; Adolescent; Drug Resistance; Graft vs Host Disease; 03 medical and health sciences; 0302 clinical medicine; Adrenal Cortex Hormones; Humans; Child; Aged; Bone Marrow Transplantation; Peripheral Blood Stem Cell Transplantation; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Biomarkers; Blood Group Incompatibility; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cord Blood Stem Cell Transplantation; Drug Resistance; Female; Graft vs Host Disease; Hematologic Neoplasms; Humans; Immunosuppressive Agents; Male; Middle Aged; Peripheral Blood Stem Cell Transplantation; Prospective Studies; Survival Analysis; Transplantation Conditioning; Treatment Outcome; Photopheresis; Immunology and Allergy; Immunology; Hematology; Hemapheresis; Middle Aged; Combined Modality Therapy; 3. Good health; Blood Group Incompatibility; Child, Preschool; Hematologic Neoplasms; Female; Cord Blood Stem Cell Transplantation; Biomarkers; Immunosuppressive Agents

BackgroundExtracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD).Study Design and MethodsThe aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.ResultsThe overall response rate (ORR) for aGVHD was 65% and the complete aGVHD‐free survival was 50% (95% confidence interval [CI], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD‐free survival was 50% (95% CI, 34%‐73%). The aGVHD‐free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.ConclusionsWhile confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.