Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy.
Transfusion. 2010 Jun;50(6):1359-69. doi: 10.1111/j.1537-2995.2009.02577.x. Epub 2010 Jan 22.
Extracorporeal photochemotherapy (ECP) is a valid therapeutic option in the treatment of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). No standard clinical and laboratory criteria of response to ECP treatment are available at the moment.
Clinical and laboratory variables on 73 pediatric patients with aGVHD (n = 50) and cGVHD (n = 23) were correlated with response to ECP and survival.
An overall response (OR) was obtained in 34 of 50 (68%) aGVHD and in 16 of 23 (69.5%) cGVHD patients. Steroid tapering within 30 days of 1.3 mg/kg in OR (p = 0.004) was the sole highly significant correlation with response found in aGVHD while no correlation emerged for cGVHD (p = 0.28). Among aGVHD patients, response to ECP was inversely associated with death: among OR, deaths were 13 of 34 (38.2%), while among nonresponders, deaths were 15 of 16 (93.8%; p < 0.001). On the other hand, decrease of steroid dose at 30 days was associated with survival: for each 1 mg/kg reduction, the hazard ratio was 2.2, and the 95% confidence interval was 1.5 to 3.2 (p < 0.001). No other clinical or laboratory variables statistically associated with survival were found.
Our results demonstrate that steroid tapering within the first 30 days of ECP treatment in aGVHD and response to ECP in acute and chronic GVHD are the only variables influencing response and survival, respectively.
体外光化学疗法（ECP）是治疗急性和慢性移植物抗宿主病（分别为 aGVHD 和 cGVHD）的有效治疗选择。目前尚无针对 ECP 治疗反应的标准临床和实验室标准。
对 73 例患有 aGVHD（n = 50）和 cGVHD（n = 23）的儿科患者的临床和实验室变量与 ECP 反应和生存相关。
在 50 例 aGVHD 患者中有 34 例（68%）和在 23 例 cGVHD 患者中有 16 例（69.5%）获得总体反应（OR）。OR 中类固醇在 1.3 mg/kg 后 30 天内的减量（p = 0.004）是 aGVHD 中唯一与反应相关的高度显著相关性，而 cGVHD 则没有相关性（p = 0.28）。在 aGVHD 患者中，ECP 反应与死亡呈反比：在 OR 中，死亡 34 例中有 13 例（38.2%），而非反应者中，死亡 16 例中有 15 例（93.8%；p <0.001）。另一方面，在 30 天时类固醇剂量的减少与生存相关：每减少 1 mg/kg，风险比为 2.2，95%置信区间为 1.5 至 3.2（p <0.001）。没有发现其他与生存相关的临床或实验室变量。
我们的结果表明，在 aGVHD 中 ECP 治疗的前 30 天内类固醇的减少以及急性和慢性 GVHD 中对 ECP 的反应是影响反应和生存的唯一变量。
