Hacettepe University Cancer Institute, Ankara, Turkey.
Division of Nephrology and Hypertension, Apheresis Unit, University of California San Diego Health, La Jolla, CA, USA.
Hematology. 2022 Dec;27(1):785-794. doi: 10.1080/16078454.2022.2095884.
Chronic graft versus host disease (chronic GVHD) still remains the leading cause of late morbidity and mortality for allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. In this retrospective study, 53 consecutive allo-HSCT patients with chronic GVHD refractory to corticosteroids were treated with extracorporeal photopheresis (ECP).
This study was performed as a retrospective single-center study. Medical records of a total of 59 patients treated with ECP for chronic GVHD were reviewed.
Best organ responses to ECP were observed in skin, mouth mucosa, eyes and liver. Overall response rate (ORR) to ECP was 81.2% (CR 17% and PR 64.2%). Overall survival (OS) was 84.9% and 36.7%, at 1 and 3 years, respectively. Female sex appears to have an advantage on ORR. Patients achieving ORR were able to maintain their responses with a prolonged continuation of treatments for +6 and +12 months indicating the benefits of longer ECP treatment.
We found that patients with chronic GVHD who were treated with ECP for 12 months or longer had a higher response rate. Our findings in line with the data reported previously suggest that patients responding to ECP should continue longer therapy schedules to achieve a better and sustained response. In our cohort, long-term ECP therapy was safe and well-tolerated with no significant adverse effects. Best responses were observed in the patients with skin, eye, liver and oral involvement. The ECP procedure offers the advantage relative to the problems with typical immunosuppressive agents. The female sex appeared to have an advantage based on the cumulative probability of the OR after ECP for chronic GVHD.
慢性移植物抗宿主病（chronic GVHD）仍然是异基因造血干细胞移植（allo-HSCT）受者晚期发病率和死亡率的主要原因。在这项回顾性研究中，对 53 例类固醇难治性慢性 GVHD 的 allo-HSCT 患者进行了体外光化学疗法（ECP）治疗。
本研究为回顾性单中心研究。共回顾了 59 例接受 ECP 治疗慢性 GVHD 的患者的病历。
皮肤、口腔黏膜、眼睛和肝脏对 ECP 的最佳器官反应。ECP 的总体反应率（ORR）为 81.2%（完全缓解率 17%，部分缓解率 64.2%）。总体生存率（OS）分别为 84.9%和 36.7%，分别为 1 年和 3 年。女性在 ORR 方面似乎具有优势。达到 ORR 的患者在延长治疗+6 和+12 个月后能够维持其反应，这表明延长 ECP 治疗的益处。
我们发现接受 ECP 治疗 12 个月或更长时间的慢性 GVHD 患者的反应率更高。我们的发现与先前报道的数据一致，表明对 ECP 有反应的患者应继续延长治疗方案，以获得更好和持续的反应。在我们的队列中，长期 ECP 治疗是安全且耐受良好的，没有明显的不良反应。皮肤、眼睛、肝脏和口腔受累的患者观察到最佳反应。与典型免疫抑制剂相比，ECP 具有优势。根据 ECP 治疗慢性 GVHD 后 OR 的累积概率，女性似乎具有优势。
