Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility and results


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SUMMARY: We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of


steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98–8/01). Only SD or SR patients who were


treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria.


All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by


visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids,


tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12–98) over a median of 5.3 months (range 1–28), with a median of six sessions per month. The


complete response (CR) rate was 22% (_n_=7) and the partial response rate was 34% (_n_=11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients


achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due


to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays


a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and


cGVHD-related morbidity and mortality remain high. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS


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institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS ROLE OF EXTRACORPOREAL PHOTOPHERESIS IN THE MANAGEMENT OF ACUTE AND CHRONIC


GRAFT VERSUS DISEASE: CURRENT STATUS Article 03 July 2024 RANDOMIZED PHASE II TRIAL OF EXTRACORPOREAL PHOTOTHERAPY AND STEROIDS VS. STEROIDS ALONE FOR NEWLY DIAGNOSED ACUTE GVHD Article 04


January 2021 EXTRACORPOREAL PHOTOPHERESIS IN ACUTE AND CHRONIC STEROID‑REFRACTORY GRAFT-VERSUS-HOST DISEASE: AN EVOLVING TREATMENT LANDSCAPE Article Open access 24 September 2022 REFERENCES


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Therakos, Inc., and was presented in part at the American Society of Hematology 43rd Annual Meeting, December 2001 in Orlando, FL, USA. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS *


Department of Dermatology, MD Anderson Cancer Center, Houston, TX, USA N Apisarnthanarax & M Duvic * Department of Blood and Marrow Transplantation, MD Anderson Cancer Center, Houston,


TX, USA M Donato, M Körbling, D Couriel, J Gajewski, S Giralt, I Khouri, C Hosing, R Champlin & P Anderlini Authors * N Apisarnthanarax View author publications You can also search for


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can also search for this author inPubMed Google Scholar * M Duvic View author publications You can also search for this author inPubMed Google Scholar * P Anderlini View author publications


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_et al._ Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell


transplantation: feasibility and results. _Bone Marrow Transplant_ 31, 459–465 (2003). https://doi.org/10.1038/sj.bmt.1703871 Download citation * Received: 05 June 2002 * Accepted: 29


September 2002 * Published: 28 March 2003 * Issue Date: 01 March 2003 * DOI: https://doi.org/10.1038/sj.bmt.1703871 SHARE THIS ARTICLE Anyone you share the following link with will be able


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initiative KEYWORDS * extracorporeal photopheresis * graft-versus-host disease * chronic GVHD * allogeneic stem cell transplantation