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Extracorporeal photopheresis in children with graft‐versus‐host disease
Author(s) -
Chan Ka Wah
Publication year - 2006
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20087
Subject(s) - medicine , extracorporeal photopheresis , photopheresis , graft versus host disease , host (biology) , immunology , surgery , transplantation , lymphoma , ecology , biology
Acute and chronic graft‐versus‐host disease (GVHD) are major complications after allogeneic hematopoietic stem cell transplantation. Systemic corticosteroid is the first line of therapy but only half of the patients will respond. The management of steroid‐refractory or steroid‐dependent GVHD is challenging. Intensification of immunosuppression has been the main strategy but the response rate is not satisfactory. Furthermore, the incidence of treatment‐related toxicity and opportunistic infection is unacceptably high.Extracorporel photopheresis (ECP) has been used in the management of refractory GVHD. Retrospective analysis of the experience in adult patients showed activity in both acute and chronic GVHD. The procedure was well tolerated with minimal changes in the hematologic and biochemical parameters. However the machine currently approved is designed for patients over 40 kg of body weight. Significant fluid shift and venous access are major concerns when ECP is performed in children. Various modifications of the ECP procedure have been tried to manage patients with low body weight. Experience with ECP in children is limited but preliminary data also showed favorable response in children with resistant GVHD. Further investigations are needed to refine the optimal schedule, duration, and treatment technique for pediatric patients. J. Clin. Apheresis 21:60–64, 2006. © 2006 Wiley‐Liss, Inc.