Extracorporeal photopheresis in the treatment of patients with refractory chronic graft-versus-host disease after allogeneic bone marrow transplantation

Abstract

AIM: To evaluate the efficiency of extracorporeal photopheresis (ECP) in the treatment of patients with refractory chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT)/MATERIAL AND METHODS: The study included 49 patients aged 2 to 55 years. Allo-HSCT was carried out in 38 (79%) patients with acute leukemias, 5 (10%) with chronic leukemias, 4 (8%) with myelodysplastic syndrome/myeloproliferative disease, and 2 (3%) with other hematologic diseases. The patients included in the study had glucocorticosteroid (GCS)-refractory disseminated cGVHD or a history of severe complications from GCS therapy/RESULTS: When evaluating the efficiency of therapy, its response was recorded in 37 (77%) cases; the best results were obtained in patients with hepatic (82%), mucosal (76%), and skin (74%) lesions. The mean severity according to the cGVHD Working Group, National Institutes of Health, and a platelet level of more than 100·109/l were defined as factors improving a therapy response. In the patients receiving ECP, the overall survival was 70%. The latter was higher in the group of patients who had responded to ECP therapy without involving the gastrointestinal tract in the cGVHD process and in those receiving a combination of ECP and other immunosuppressive drugs/CONCLUSION: ECP is an effective treatment for patients with refractory cGVHD, it may be used in those with a history of severe complications from GCS therapy. ECP allows the dose of GCS to be reduced to the point of complete discontinuation.

Full Text

Экстракорпоральный фотоферез в лечении больных с рефрактерными формами хронической реакции трансплантат против хозяина после аллогенной трансплантации костного мозга. - Резюме. Цель исследования. Оценить эффективность экстракорпорального фотофереза (ЭКФ) в лечении больных с рефрактерными формами хронической реакции трансплантат против хозяина (хРТПХ) после аллогенной трансплантации гемопоэтических стволовых клеток (алло-ТГСК). Материалы и методы. В исследование включили 49 пациентов в возрасте от 2 до 55 лет. Алло-ТГСК выполнена в связи с острыми лейкозами у 38 (79%) пациентов, с хроническими лейкозами - у 5 (10%), с миелодиспластическим синдромом/миелопролиферативным заболеванием - у 4 (8%), с другими гематологическими заболеваниями - у 2 (3%). У больных, включенных в исследование, имелась распространенная форма хРТПХ, рефрактерная к глюкокортикостероидам (ГКС), или тяжелые осложнения после терапии ГКС в анамнезе. Результаты. При оценке эффективности ответ на терапию зарегистрирован в 37 (77%) случаях, наилучшие результаты получены при поражении печени (82%), слизистых оболочек (76%) и кожи (74%). Средняя степень тяжести по критериям Рабочей группы хРТПХ Национального института здоровья и уровень тромбоцитов более 100·109/л определены как факторы, улучшающие ответ на терапию. Общая выживаемость (ОВ) пациентов, получивших ЭКФ, составила 70%. ОВ была выше в группе пациентов, ответивших на терапию ЭКФ, без вовлечения в процесс хРТПХ желудочно-кишечного тракта и у пациентов, получивших комбинацию ЭКФ и других иммуносупрессивных препаратов. Заключение. ЭКФ является эффективным методом лечения больных с рефрактерными формами хРТПХ, может использоваться в случае тяжелых осложнений лечения ГКС в анамнезе. ЭКФ позволяет снизить дозу ГКС вплоть до полной отмены.
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Copyright (c) 2013 Bykova T.A., Kozlov A.V., Stancheva N.V., Semenova E.V., Kulagina I.I., Bondarenko S.N., Vavilov V.N., Morozova E.V., Zubarovskaia L.S., Afanas'ev B.V.

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