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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 good treatment option for children with acute or chronic GVHD, with notable response rates in skin and other organs.
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 the demographic characteristics of pediatric patients undergoing ECP for GVHD.
- To assess the clinical response, adverse effects, and overall outcomes of ECP in pediatric acute and chronic GVHD.
- To provide insights into ECP as a treatment modality for pediatric GVHD.
Main Methods:
- Retrospective analysis of 9 pediatric patients with acute or chronic GVHD treated with ECP.
- Utilized UVAR-XTS™ and CELLEX systems for ECP administration.
- Treatment protocols varied based on GVHD type (acute vs. chronic) with defined reassessment intervals.
Main Results:
- Seven out of nine pediatric patients showed a positive response to ECP.
- Complete skin response was observed in 1 patient, with partial response in 7.
- Significant response rates were noted for liver (60%), gastrointestinal system (50%), and mucous membranes (80%).
Conclusions:
- Extracorporeal photopheresis (ECP) demonstrates potential as a valuable treatment for pediatric patients suffering from acute or chronic GVHD.
- ECP offers a viable therapeutic option for managing refractory, dependent, or resistant GVHD in children.
- Further research may elucidate optimal ECP protocols for pediatric GVHD management.
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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