Kanold Justyna, Paillard Catherine, Halle Pascale, D'Incan Michel, Bordigoni Pierre, Deméocq François
Unité Bioclinique de Thérapie Cellulaire, Service d'Hématologie et d'Oncologie Pédiatrique, Hôtel Dieu, CHU, BP69, 11, Boulevard Léon Malfreyt 63003 Clermont-Ferrand, France.
Transfus Apher Sci. 2003 Feb;28(1):71-80. doi: 10.1016/S1473-0502(02)00102-7.
Although worldwide experience with extracorporeal photochemotherapy (ECP) for GvHD treatment has grown enormously over the past decade, only a few pediatric centers have experience with ECP. Studies reporting clinical outcome in children with GvHD treated by ECP comprises a very limited number of patients with only few information described. This review article remain focused on the efficacy and the safety aspect of ECP in pediatric patients to provide information about the steps that should be taken to overcome the difficulties with ECP use in children with GvHD. Data concerning 19 children with acute GvHD and 54 children with chronic GvHD treated with ECP and reported so far have been considered. The principal reasons for the restriction in the use of ECP in children such as: (1) technical difficulties of leukapheresis procedures (venous access, hemodynamic, metabolic and hematological tolerance); and (2) the necessity of a specially adapted pediatric patient approach to improve the psychological tolerance of this treatment are discussed. The data of this retrospective review demonstrate that ECP is beneficial and well tolerated in children with GvHD. It can be safely used even in young children with low body weight and a poor performance status when it was performed by a qualified pediatric team. The observations concerning the response rate and onset suggest that in children with acute GvHD, ECP should be started early in the course of disease and employed over a relatively short period of time. As far as chronic GvHD is concerned, despite the fact that it is preferable to begin ECP early as second line therapy, it may also be beneficial in patients with late-stage disease.
尽管在过去十年中，全球范围内使用体外光化学疗法（ECP）治疗移植物抗宿主病（GvHD）的经验大幅增加，但只有少数儿科中心有ECP治疗经验。报告ECP治疗GvHD患儿临床结果的研究包含的患者数量非常有限，且描述的信息很少。这篇综述文章仍聚焦于ECP在儿科患者中的疗效和安全性，以提供关于应对GvHD患儿使用ECP困难应采取步骤的信息。已考虑了目前报道的19例接受ECP治疗的急性GvHD患儿和54例慢性GvHD患儿的数据。文中讨论了儿童使用ECP受限的主要原因，如：（1）白细胞分离术操作的技术困难（静脉通路、血流动力学、代谢和血液学耐受性）；（2）需要采用特别适合儿科患者的方法来提高对这种治疗的心理耐受性。这项回顾性研究的数据表明，ECP对GvHD患儿有益且耐受性良好。由合格的儿科团队进行时，即使是低体重和身体状况较差的幼儿也可安全使用。关于缓解率和起效时间的观察结果表明，对于急性GvHD患儿，应在病程早期开始ECP治疗，并在相对较短的时间内使用。就慢性GvHD而言，尽管最好尽早将ECP作为二线治疗开始使用，但对晚期疾病患者也可能有益。
