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Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease
K Y Cueto Sarmiento1, J A Baquero Rey1, A Andrade Miranda1
1Sección de Fotoféresis, Fototerapia y Linfomas Cutáneos, Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Extracorporeal photopheresis (ECP) effectively treats pediatric graft-vs-host disease (GVHD). This study shows ECP offers a viable treatment option for children with acute or chronic GVHD, with significant response rates observed.
Area of Science:
- Pediatric Hematology/Oncology
- Immunomodulatory Therapies
- Graft-vs-Host Disease Research
Background:
- Extracorporeal photopheresis (ECP) is an established immunomodulatory therapy for graft-vs-host disease (GVHD).
- Limited research exists on ECP's efficacy and safety in pediatric populations.
- This study addresses the need for more data on ECP in children with GVHD.
Purpose of the Study:
- To evaluate demographic characteristics of pediatric patients receiving ECP for GVHD.
- To assess clinical response rates and adverse events associated with ECP treatment.
- To determine overall outcomes in children with acute or chronic GVHD treated with ECP.
Main Methods:
- Retrospective analysis of 9 pediatric patients with refractory/resistant GVHD treated between 2012-2018.
- Utilized UVAR-XTS™ and CELLEX systems for ECP procedures.
- Treatment protocols varied based on acute (2x weekly) or chronic (2x bi-weekly) GVHD, with reassessment at 1 and 3 months, respectively.
Main Results:
- Seven out of nine pediatric patients showed a response to ECP.
- Complete skin response in 1/9, partial in 7/9. Other complete response rates: liver 60%, GI 50%, mucous membranes 80%.
- Two patients experienced fatal outcomes during the study period.
Conclusions:
- Extracorporeal photopheresis (ECP) demonstrates promise as a treatment for pediatric GVHD.
- ECP can be a valuable therapeutic option for children with acute or chronic GVHD.
- Further research is warranted to optimize ECP protocols and outcomes in pediatric patients.
Background:
Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children.
Objective:
To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP.
Material And Methods:
We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response.
Results:
We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period.
Conclusion:
ECP is a good treatment option for pediatric patients with acute or chronic GVHD.
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