Rossetti F, Dall'Amico R, Crovetti G, Messina C, Montini G, Dini G, Locatelli F, Argiolu F, Miniero R, Zacchello G
Department of Pediatrics, University of Padua, Italy.
Bone Marrow Transplant. 1996 Nov;18 Suppl 2:175-81.
Photopheresis is an extracorporeal photochemotherapy (ECP) used for the treatment of oncological and autoimmune diseases. Lymphocytes are drawn from the patients by leukapheresis, treated with 8-methoxypsoralen (8-MOP) and ultraviolet light A (UVA) in an extracorporeal system; then, reinfused to the host. Because skin exposure to 8-MOP and UVA (PUVA) has been shown to improve cutaneous GVHD, we evaluated in a pilot study, if ECP might be beneficial for patients with GVHD unresponsive to conventional protocols. In this study, we enrolled 9 children or young adults, with acute (no = 1) or chronic extensive GVHD (no. = 8). A significant improvement was observed in three of the 5 patients with scleroderma-like lesions and in one patient with severe liver involvement. Karnofsky performance score improved from 30-50% to 90% in the 4 responders. The better control of GVHD in these patients allowed a reduction of the immunosuppressive therapy that was, finally, discontinued in two. No significant side effects were observed during ECP. Our results suggest that ECP is a nonaggressive treatment that may benefit patients with c-GVHD unresponsive to standard immunosuppressive therapies.
光化学疗法是一种用于治疗肿瘤和自身免疫性疾病的体外光化学疗法（ECP）。通过白细胞分离术从患者体内采集淋巴细胞，在体外系统中用8-甲氧基补骨脂素（8-MOP）和紫外线A（UVA）进行处理；然后，再回输到宿主体内。由于皮肤暴露于8-MOP和UVA（PUVA）已被证明可改善皮肤移植物抗宿主病（GVHD），我们在一项初步研究中评估了ECP对常规方案无反应的GVHD患者是否有益。在这项研究中，我们招募了9名儿童或年轻人，其中急性GVHD患者1例，慢性广泛性GVHD患者8例。5例硬皮病样病变患者中有3例以及1例严重肝脏受累患者病情有显著改善。4例有反应的患者的卡诺夫斯基表现评分从30%-50%提高到了90%。这些患者对GVHD的更好控制使得免疫抑制治疗得以减少，最终有2例患者停止了治疗。在ECP期间未观察到明显的副作用。我们的结果表明，ECP是一种无侵袭性的治疗方法，可能对标准免疫抑制疗法无反应的慢性GVHD患者有益。
