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


Cite item

Full Text

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.
×

References

  1. Lee S.J. Have we made progress in the management of chronic graft-vs-host disease? Best Pract Res Clin Haematol 2010; 23 (4): 529-535.
  2. Shulman H.M., Sullivan K.M., Weiden P.L. et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204-217.
  3. Pavletic S.Z., Martin P., Lee S.J. et al. Response Criteria Working Group Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report. Biol Blood Marrow Transplant 2006; 12 (3): 252-266.
  4. Filipovich A.H., Weisdorf D., Pavletic S. et al. National Institutes of Health consensus development project on criteria for clinical trials in chron- ic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11 (12): 945-956.
  5. Koc S., Leisenring W., Flowers M.E. et al. Therapy for chronic graft-versus-host disease: a randomized trial comparing cyclosporine plus prednisone versus prednisone alone. Blood 2002; 100: 48-51.
  6. Martin P.J., Weisdorf D., Przepiorka D. et al. Design of Clinical Trials Working Group. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: VI. Design of Clinical Trials Working Group report. Biol Blood Marrow Transplant 2005 12 (5): 491-505.
  7. Wolff D., Schleuning M., von Harsdorf S. et al. Consensus Conference on Clinical Practice in Chronic GVHD: Second-Line Treatment of Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2011; 17 (1): 1-17.
  8. Dignan F.L., Amrolia P., Clark A. et al. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol 2012; 158: 46-61.
  9. Couriel D., Carpenter P.A., Cutler C. et al. Ancillary therapy and supportive care of chronic graft-versus-host disease: national institutes of health consensus development project on criteria for clinical trials in chronic Graft-versus-host disease: V. Ancillary Therapy and Supportive Care Working Group report. Biol Blood Marrow Transplan 2006; 12 (4): 375-396.
  10. Dignan, F.L., Greenblatt, D., Cox. M. et al. Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD. Bone Marrow Transplant 2012; 47 (6): 824-830.
  11. Greinix H.T., Socie G., Bacigalupo A. et al. Assessing the potential role of photopheresis in hematopoietic stem cell transplant. Bone Marrow Transplant 2006; 38 (4): 265-273.
  12. Seaton E.D., Szydlo R.M., Kanfer E. et al. Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response. Blood 2003; 102 (4): 1217-1223.
  13. Foss F.M., DiVenuti G.M., Chin K. et al. Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors. Bone Marrow Transplant 2005; 35 (12): 1187-1193.
  14. Child F.J., Ratnavel R., Watkins P. et al. Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD). Bone Marrow Transplant 1999; 23 (9): 881-887.
  15. Apisarnthanarax N., Donato M., Kobling M. et al. Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility an/RESULTS: Bone Marrow Transplant 2003; 31 (3): 459-465.
  16. Messina C., Locatelli F., Lanino E. et al. Extracorporeal photochemotherapy for paediatric patients with graft-versus-host disease after haematopoietic stem cell transplantation. Br J Haematol 2003; 122 (1): 118-127.
  17. Scarisbrick J. Extracorporeal photopheresis: what is it and when should it be used? Clin Exper Dermatol 2009; 34 (7): 757-760.
  18. Flowers M.E., Apperley J.F., van Besien K. et al. A multicenter prospective phase 2 randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease. Blood 2008; 112 (7): 2667-2674.
  19. Greinix H.T., van Besien K., Elmaagacli A.H. et al. UVADEX Chronic GVHD Study Group. Progressive improvement in cutaneous and extracutaneous chronic graft-versus-host disease after a 24-week course of extracorporeal photopheresis - results of a crossover randomized study. Biol Blood Marrow Transplant 2011; 17 (12): 1775-1782.
  20. Couriel D.R., Hosing C., Saliba R. et al. Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD. Blood 2006; 107 (8): 3074-3080.
  21. Hautmann A.H., Wolff D., Hahn J. et al. Extracorporeal photopheresis in 62 patients with acute and chronic GVHD: Results of treatment with the COBE Spectra System. Bone Marrow Transplant 2013; 48 (3): 439-445. doi: 10.1038/bmt.2012.156

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2013 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies