Department of Hematology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, CopenhagenØ, 2100, Denmark.
Department of Dermatology, Bispebjerg hospital, University of Copenhagen, København, Denmark.
Bone Marrow Transplant. 2019 Jan;54(1):35-43. doi: 10.1038/s41409-018-0206-5. Epub 2018 May 8.
Improvement in chronic graft vs. host disease (cGvHD) following treatment with extracorporeal photopheresis (ECP) has been shown previously. However, the effect is often measured at only one point in time or as best response. Chronic GvHD activity fluctuates over time, so we retrospectively evaluated cGvHD responses in 54 patients with primarily moderate or severe cGvHD throughout the ECP treatment course and after stopping ECP. The dominant response was partial remission (PR) in 33 patients, no change (NC) in 10 patients, progressive disease (PD) in 10 patients and complete remission (CR) in one patient. Response rates and reduction in glucocorticoid dose reached a plateau after nine months. The main reason for stopping ECP was the absence of further improvement. Flares in cGvHD activity were seen in 36 patients. Additional treatment during ECP was administered to 29 patients. Failure free survival with response was achieved for 52% of patients at 6 months and 43% at 1 year. Our study confirms that ECP is a safe option for cGvHD therapy. The majority of the patients experience improvement and reduction in glucocorticoid dose but flares in cGvHD activity and the need for additional immunosuppression are seen frequently.
先前已经证明，体外光分离术（ECP）可改善慢性移植物抗宿主病（cGvHD）。然而，这种效果通常仅在一个时间点或最佳反应时进行测量。慢性 GvHD 的活动随时间波动，因此我们回顾性地评估了 54 例主要为中度或重度 cGvHD 的患者在整个 ECP 治疗过程中和停止 ECP 后的 cGvHD 反应。33 例患者的主要反应为部分缓解（PR），10 例患者无变化（NC），10 例患者疾病进展（PD），1 例患者完全缓解（CR）。反应率和糖皮质激素剂量的减少在九个月后达到平台期。停止 ECP 的主要原因是没有进一步改善。36 例患者出现 cGvHD 活动的复发。29 例患者在 ECP 期间接受了额外治疗。6 个月时，52%的患者和 1 年时 43%的患者实现了无进展生存和反应。我们的研究证实，ECP 是治疗 cGvHD 的安全选择。大多数患者的病情改善，糖皮质激素剂量减少，但 cGvHD 活动复发和需要额外免疫抑制的情况很常见。
