Whittle Robert M, Denney Helen, Chantry Andrew D, Alfred Arun, Taylor Peter C
Photopheresis Unit, Rotherham NHS Trust, Rotherham, South Yorkshire, United Kingdom.
Sheffield Myeloma Research Team, Department of Oncology and Metabolism, University of Sheffield Medical School, United Kingdom.
J Clin Apher. 2017 Dec;32(6):462-473. doi: 10.1002/jca.21541. Epub 2017 Jun 13.
Extracorporeal Photopheresis (ECP) is a cellular immunotherapy frequently used for steroid-refractory graft-versus-host disease (GVHD). Chronic GVHD (cGVHD), response to ECP is associated with survival benefit. The UVAR-XTS system and the more recently developed CELLEX device (both Therakos ) are the mainstay for ECP-delivery in the UK and US. No comparison of treatment outcomes has been reported. We retrospectively compared cGVHD response and steroid reduction and withdrawal in patients treated exclusively over 12 months with either the XTS (n = 51) or CELLEX (n = 50). Our hypothesis was that there would be no difference in clinical outcome or steroid changes in the 2 matched cohorts. We also compared infection incidence, infection-related death (IRD), and treatment time. Significant clinical improvement and regular capacity to reduce or cease steroids was encountered in both cohorts; at 6 months of ECP 70% of cutaneous cGvHD patients had partial or complete responses and 85% of patients receiving steroids pre-ECP had reduced dosage. In the XTS group we unexpectedly encountered both superior steroid reduction (86% dose at least halved vs. 61% for CELLEX, P = 0.01) and withdrawal (15 vs. 5 CELLEX, P = 0.01) and a trend for superior skin disease response in the CELLEX-treated cohort at 3 months. No inter-relationship was evident. Halving or greater reduction of steroid dose by 3 or 6 months was associated with reduced risk of IRD in the XTS cohort as was withdrawal at 6 months for the combined cohorts. By 6 months, XTS-treated patients had experienced fewer antibiotic-requiring infections (mean 1.9 vs. 2.8, P = 0.025). Origins for the disparities are unclear and warrant investigation.
体外光化学疗法（ECP）是一种细胞免疫疗法，常用于治疗对类固醇难治的移植物抗宿主病（GVHD）。对于慢性GVHD（cGVHD），ECP的反应与生存获益相关。UVAR-XTS系统和最近开发的CELLEX设备（均为Therakos公司产品）是英国和美国进行ECP治疗的主要设备。目前尚未有关于治疗结果比较的报道。我们回顾性比较了仅接受12个月以上XTS（n = 51）或CELLEX（n = 50）治疗的患者的cGVHD反应、类固醇减量和停药情况。我们的假设是，两个匹配队列的临床结果或类固醇变化没有差异。我们还比较了感染发生率、感染相关死亡（IRD）和治疗时间。两个队列均出现了显著的临床改善以及定期减少或停用类固醇的能力；在ECP治疗6个月时，70%的皮肤cGvHD患者有部分或完全反应，85%在ECP治疗前接受类固醇治疗的患者减少了剂量。在XTS组中，我们意外地发现类固醇减量效果更好（86%的剂量至少减半，而CELLEX组为61%，P = 0.01）以及停药情况更好（XTS组15例，CELLEX组5例，P = 0.01），并且在3个月时CELLEX治疗队列的皮肤病反应有更好的趋势。未发现明显的相互关系。在XTS队列中，到3个月或6个月时类固醇剂量减半或更大程度减少与IRD风险降低相关，联合队列在6个月时停药也与IRD风险降低相关。到6个月时，接受XTS治疗的患者需要使用抗生素的感染较少（平均1.9次 vs. 2.8次，P = 0.025）。差异的原因尚不清楚，值得研究。
