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Extracorporeal photopheresis for graft‐vs‐host disease: A literature review and treatment guidelines proposed by the Nordic ECP Quality Group
Author(s) -
Nygaard Marietta,
Wichert Stina,
Berlin Gösta,
Toss Fredrik
Publication year - 2020
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13381
Subject(s) - extracorporeal photopheresis , medicine , photopheresis , intensive care medicine , graft versus host disease , treatment modality , modalities , evidence based medicine , disease , best evidence , surgery , pediatrics , alternative medicine , pathology , social science , sociology
Extracorporeal photopheresis (ECP) is one of the most used and established therapies for steroid‐refractory graft‐vs‐host disease (GvHD), with a good effect to side effect profile. In this review, we present a summary of present literature and provide evidence‐based treatment guidelines for ECP in GvHD. The guidelines constitute a consensus statement formed by the Nordic ECP Quality Group representing all ECP centres in the Nordic countries, and aims to facilitate harmonisation and evidence‐based practice. In developing the guidelines, we firstly conducted a thorough literature search of original articles and existing guidelines. In total, we identified 26 studies for ECP use in acute GvHD and 36 in chronic GvHD. The studies were generally small, retrospective and heterogeneous regarding patient characteristics, treatment schedule and outcome assessment. In general, a majority of patients achieved partial response or better, but response rates varied by the organs affected. Head‐to‐head comparisons to other treatment modalities were lacking. Overall, we consider the quality of evidence to be low–moderate (GRADE) and encourage future prospective multi‐armed trials to strengthen the present recommendations. However, despite limitations in evidence strength, standardised treatment schedules and regular follow‐up are imperative to ensure the best possible patient outcome.