Worel Nina, Lehner Elisabeth, Führer Harald, Kalhs Peter, Rabitsch Werner, Mitterbauer Margit, Hopfinger Georg, Greinix Hildegard T
Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna.
Institute of Mathematics, University of Natural Resources and Life Sciences.
Transfusion. 2018 Apr;58(4):1045-1053. doi: 10.1111/trf.14506. Epub 2018 Feb 15.
Extracorporeal photopheresis (ECP) has demonstrated efficacy as second-line treatment for steroid-refractory (SR) acute graft-versus-host disease (aGVHD). The aim of our study was to analyze whether the amount of ECP-treated cells in patients with SR, aGVHD has an impact on response at 1 month.
Data on white blood cells, lymphocytes, monocytes, mononuclear cells, and neutrophils, including absolute counts and counts per kilogram of body weight in ECP products from patients with aGVHD, were collected. For each cell population, the median dose per single ECP and the cumulative doses collected during the first week and the first month of treatment were compared with the response to ECP.
In total, 99 patients underwent 1215 ECP procedures. Overall response was defined as a complete response if all signs of aGVHD resolved or a partial response if greater than 50% resolution was reached without other, additional immunosuppression. An overall response was obtained by 75% of patients, including 53% complete responses. Univariate analysis showed a correlation of lymphocytes and mononuclear cells/kg body weight for a single procedure and overall response. In logistic regression analysis, no tested variable had an influence on response. In receiver operating characteristic curve analysis, cutoffs of 8.4 × 10 /kg body weight lymphocytes and 13.9 × 10 /kg body weight mononuclear cells were associated with an overall response to ECP at 1 month with 75% sensitivity.
Our results in patients with steroid-refractory aGVHD confirm that response rates to ECP are high and that certain cutoff values for lymphocytes and mononuclear cells/kg body weight in each individual procedure can predict an overall response to ECP at 1 month.
体外光化学疗法（ECP）已被证明可作为类固醇难治性（SR）急性移植物抗宿主病（aGVHD）的二线治疗方法。我们研究的目的是分析SR-aGVHD患者接受ECP治疗的细胞数量是否会对1个月时的反应产生影响。
收集了aGVHD患者ECP产品中的白细胞、淋巴细胞、单核细胞、单个核细胞和中性粒细胞的数据，包括绝对计数和每千克体重的计数。对于每个细胞群体，将单次ECP的中位剂量以及治疗第一周和第一个月收集的累积剂量与ECP反应进行比较。
共有99例患者接受了1215次ECP治疗。如果aGVHD的所有体征均消失，则总体反应定义为完全缓解；如果在没有其他额外免疫抑制的情况下缓解率超过50%，则定义为部分缓解。75%的患者获得了总体缓解，其中53%为完全缓解。单因素分析显示，单次治疗的淋巴细胞和单个核细胞/千克体重与总体反应相关。在逻辑回归分析中，没有测试变量对反应有影响。在受试者工作特征曲线分析中，淋巴细胞8.4×10⁶/kg体重和单个核细胞13.9×10⁶/kg体重的临界值与1个月时ECP的总体反应相关，敏感性为75%。
我们在类固醇难治性aGVHD患者中的研究结果证实，ECP的反应率很高，并且每次治疗中淋巴细胞和单个核细胞/千克体重的特定临界值可以预测1个月时对ECP的总体反应。
