Rafei Hind, Kharfan-Dabaja Mohamed A, Nishihori Taiga
Department of Internal Medicine, George Washington University School of Medicine, Washington, DC 20052, USA.
Department of Blood & Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
Biomedicines. 2017 Oct 11;5(4):60. doi: 10.3390/biomedicines5040060.
Although significant advances have been made in the biologic understanding of graft-versus-host disease (GVHD) and its treatment options, GVHD remains the single most challenging obstacle to the success of allogeneic hematopoietic cell transplantation (HCT) due to high risk of disabling morbidity and mortality. Extracorporeal photopheresis (ECP) has promising effects in controlling steroid-refractory GVHD, both acute and chronic, and it has been studied extensively. Its putative immunomodulatory mechanisms, while not immunosuppressive, position ECP as an attractive treatment strategy for GVHD patients who are already receiving global immunosuppression. However, ECP is relatively underutilized due in part to limited access and time commitment. Here, we review the recent findings on the ECP efficacy in both acute and chronic GVHD, primarily for steroid-refractory status, and we critically appraise its benefits. We also explore salient considerations on the optimal use of ECP in the treatment of refractory GVHD.
尽管在移植物抗宿主病（GVHD）的生物学理解及其治疗选择方面已经取得了重大进展，但由于致残性发病率和死亡率的高风险，GVHD仍然是异基因造血细胞移植（HCT）成功的最具挑战性的单一障碍。体外光化学疗法（ECP）在控制急性和慢性类固醇难治性GVHD方面具有显著效果，并且已经进行了广泛的研究。其假定的免疫调节机制虽然不是免疫抑制性的，但使ECP成为已经接受全身免疫抑制的GVHD患者的一种有吸引力的治疗策略。然而，ECP的使用相对不足，部分原因是获取途径有限和时间投入问题。在此，我们回顾了关于ECP在急性和慢性GVHD中疗效的最新发现，主要针对类固醇难治状态，并对其益处进行批判性评估。我们还探讨了在难治性GVHD治疗中最佳使用ECP的突出考虑因素。
