Schooneman F, Claise C
Blood Transfusion Centre, Vandoeuvre Les Nancy, France.
Transfus Sci. 1996 Dec;17(4):527-36.
Graft versus host disease (GVHD), whether acute or chronic, is a frightening complication of bone marrow allografts-indeed in many cases it can be life threatening. In chronic GVHD, the symptoms are less serious, but they can nevertheless be alarming. The mechanism of this reaction is very complex and the pathogenesis of chronic GVHD seems to be slightly different from that of acute GVHD. However, there is no doubt about the immune mechanisms. The production of numerous cytokines plays an important part and has also been des-cribed. Until the use of photopheresis, the only treatments that were effective to any degree have been immunosuppressive treatments. Extracorporeal photopheresis (ECP), a technique recently proposed in chronic GVHD, is promising and is believed to attack the actual cause of the disease (the role of cytotoxic T lymphocytes is now recognized). ECP is believed to have a complex mechanism of action, the explanation of an anti-T lymphocyte action of ECP seems too simple. We report the results of three patients suffering from chronic GVHD, refractory to the usual treatments. The schedule for ECP was a cycle of two treatments every 2 weeks. We recorded a complete remission for patient No. 1 (grade 1) with no relapse for now 3 years. In patient No. 2 (grade 2-3) a progressive improvement was observed in the various symptoms with, however, several episodes of aggravation. In patient No. 3 (grade 2-3), the skin symptoms improved and the lichen planus lesions healed after only 15 months of treatment (interrupted by two infectious episodes during which ECP was stopped). Although the study population was small, we may be justified in thinking that ECP can cause an improvement in chronic GVHD refractory to immunosuppressive treatment. These results should be confirmed by a rigorously designed multicentre study.
移植物抗宿主病（GVHD），无论是急性还是慢性，都是骨髓同种异体移植令人恐惧的并发症——事实上，在许多情况下它可能危及生命。在慢性GVHD中，症状虽不那么严重，但仍可能令人担忧。这种反应的机制非常复杂，慢性GVHD的发病机制似乎与急性GVHD略有不同。然而，免疫机制是毫无疑问的。众多细胞因子的产生起着重要作用，也已有相关描述。在光分离置换法应用之前，唯一有一定效果的治疗方法一直是免疫抑制治疗。体外光分离置换法（ECP）是最近在慢性GVHD中提出的一种技术，很有前景，并且被认为能针对疾病的实际病因（细胞毒性T淋巴细胞的作用现已得到认可）。ECP被认为有复杂的作用机制，仅用抗T淋巴细胞作用来解释ECP似乎过于简单。我们报告了3例慢性GVHD患者的结果，这些患者对常规治疗无效。ECP的治疗方案是每2周进行一个包含两次治疗的周期。我们记录到1号患者（1级）完全缓解，至今3年未复发。2号患者（2 - 3级）各种症状逐渐改善，但有几次病情加重。3号患者（2 - 3级）仅经过15个月的治疗（期间因两次感染发作中断治疗，发作期间停止了ECP），皮肤症状改善，扁平苔藓病变愈合。尽管研究对象数量较少，但我们有理由认为ECP可使对免疫抑制治疗无效的慢性GVHD病情得到改善。这些结果应由严格设计的多中心研究予以证实。
