Chan Ka Wah
Pediatric Blood and Marrow Transplantation, Texas Transplant Institute, 8201 Ewing Halsell, Suite 280, San Antonio, 78229, USA.
J Clin Apher. 2006 Apr;21(1):60-4. doi: 10.1002/jca.20087.
Acute and chronic graft-versus-host disease (GVHD) are major complications after allogeneic hematopoietic stem cell transplantation. Systemic corticosteroid is the first line of therapy but only half of the patients will respond. The management of steroid-refractory or steroid-dependent GVHD is challenging. Intensification of immunosuppression has been the main strategy but the response rate is not satisfactory. Furthermore, the incidence of treatment-related toxicity and opportunistic infection is unacceptably high. Extracorporel photopheresis (ECP) has been used in the management of refractory GVHD. Retrospective analysis of the experience in adult patients showed activity in both acute and chronic GVHD. The procedure was well tolerated with minimal changes in the hematologic and biochemical parameters. However the machine currently approved is designed for patients over 40 kg of body weight. Significant fluid shift and venous access are major concerns when ECP is performed in children. Various modifications of the ECP procedure have been tried to manage patients with low body weight. Experience with ECP in children is limited but preliminary data also showed favorable response in children with resistant GVHD. Further investigations are needed to refine the optimal schedule, duration, and treatment technique for pediatric patients.
急性和慢性移植物抗宿主病（GVHD）是异基因造血干细胞移植后的主要并发症。全身用皮质类固醇是一线治疗方法，但只有一半的患者会有反应。难治性或依赖类固醇的GVHD的管理具有挑战性。强化免疫抑制一直是主要策略，但有效率并不令人满意。此外，治疗相关毒性和机会性感染的发生率高得令人难以接受。体外光化学疗法（ECP）已用于难治性GVHD的管理。对成年患者经验的回顾性分析显示其对急性和慢性GVHD均有疗效。该操作耐受性良好，血液学和生化参数变化极小。然而，目前获批的机器是为体重超过40公斤的患者设计的。在儿童中进行ECP时，显著的体液转移和静脉通路是主要问题。人们尝试了各种ECP程序的改良方法来治疗体重低的患者。儿童ECP的经验有限，但初步数据也显示对耐药GVHD儿童有良好反应。需要进一步研究以完善针对儿科患者的最佳方案、持续时间和治疗技术。
