Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Department of Photopheresis, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom.
Front Immunol. 2020 Jan 31;11:81. doi: 10.3389/fimmu.2020.00081. eCollection 2020.
As the use of hematopoietic stem cell transplantation (HSCT) has become a more widespread and effective treatment for hematological malignant and non-malignant conditions, the need to minimize the harmful effects of graft- vs.-host disease (GvHD) has become more important in achieving good outcomes. With diagnosis of GvHD reliant on its clinical manifestations, research into biomarkers for the diagnosis, progression, and even for the prediction of disease, is imperative to combating the high levels of morbidity and mortality post-HSCT. Despite the development of novel treatment approaches to GvHD, corticosteroids remain the standard first-line treatment, with immunosuppressant therapies as second-line options. These strategies however have significant limitations and associated complications. Extracorporeal Photopheresis (ECP) has shown to be effective and safe in treating patients with symptomatic GvHD. ECP has been shown to have varied effects on multiple parts of the immune system and does not appear to increase the risk of relapse or infection in the post HSCT setting. Even so, ECP can be logistically more complex to organize and requires patients to be sufficiently stable. This review aims to summarize the potential role of biomarkers to help guide individualized treatment decisions in patients with acute and chronic GvHD. In relation to ECP, robust biomarkers of GvHD will be highly useful in informing patient selection, intensity and duration of the ECP schedule, monitoring of response and other treatment decisions alongside the concurrent administration of other GvHD therapies. Further research is warranted to establish how GvHD biomarkers are best incorporated into ECP treatment pathways with the goal of tailoring ECP to the needs of individual patients and maximizing benefit.
随着造血干细胞移植（HSCT）的应用变得更加广泛和有效，用于治疗血液系统恶性和非恶性疾病，最大限度地减少移植物抗宿主病（GvHD）的有害影响在实现良好结果方面变得更加重要。由于 GvHD 的诊断依赖于其临床表现，因此研究用于诊断、进展甚至预测疾病的生物标志物对于对抗 HSCT 后高发病率和死亡率至关重要。尽管针对 GvHD 开发了新的治疗方法，但皮质类固醇仍然是标准的一线治疗药物，免疫抑制剂治疗是二线选择。然而，这些策略存在重大局限性和相关并发症。体外光化学疗法（ECP）已被证明在治疗有症状的 GvHD 患者方面是有效且安全的。ECP 已被证明对免疫系统的多个部分具有不同的影响，并且似乎不会增加 HSCT 后复发或感染的风险。即便如此，ECP 在组织上可能更加复杂，并且需要患者足够稳定。本综述旨在总结生物标志物的潜在作用，以帮助指导急性和慢性 GvHD 患者的个体化治疗决策。关于 ECP，用于 GvHD 的强大生物标志物将非常有助于告知患者选择、ECP 方案的强度和持续时间、对反应的监测以及其他 GvHD 治疗的其他治疗决策。需要进一步研究以确定如何将 GvHD 生物标志物最佳纳入 ECP 治疗途径，以根据患者的需求定制 ECP，并最大限度地提高获益。
