Extracorporeal photopheresis for the treatment of chronic graft versus host disease

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Chronic graft-versus-host disease (GVHD) is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• It remains a leading cause of long-term morbidity and mortality in allo-HSCT survivors.
• Standard corticosteroid therapy is often insufficient for refractory chronic GVHD cases.

Purpose of the Study:

• To evaluate the efficacy and safety of extracorporeal photopheresis (ECP) in patients with chronic GVHD resistant to corticosteroids.
• To identify factors influencing treatment response and survival outcomes.

Main Methods:

• Retrospective single-center study reviewing medical records of 59 patients with chronic GVHD treated with ECP.
• Analysis of organ-specific responses, overall response rate (ORR), and overall survival (OS).
• Evaluation of treatment duration and patient demographics (e.g., sex) as potential prognostic factors.

Main Results:

• An overall response rate (ORR) of 81.2% was observed, with complete response (CR) in 17% and partial response (PR) in 64.2%.
• Best responses were noted in skin, oral mucosa, eyes, and liver involvement.
• One-year and three-year overall survival (OS) rates were 84.9% and 36.7%, respectively. Female sex showed a potential advantage in ORR. Longer ECP treatment (≥12 months) was associated with higher response rates and sustained responses.

Conclusions:

• Extracorporeal photopheresis is an effective and safe treatment for corticosteroid-refractory chronic GVHD.
• Extended ECP therapy (≥12 months) is recommended for patients achieving initial response to improve and sustain outcomes.
• ECP offers an advantageous alternative to conventional immunosuppressive agents, with specific benefits observed in skin, eye, liver, and oral manifestations.