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Extracorporeal photopheresis for graft‐versus‐host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome—results from a large single‐center study
Author(s) -
Berger Massimo,
Albiani Roberto,
Sini Bruno,
Fagioli Franca
Publication year - 2015
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12900
Subject(s) - medicine , extracorporeal photopheresis , graft versus host disease , gastroenterology , single center , photopheresis , apheresis , hematologic disease , immunology , transplantation , disease , platelet
Background Extracorporeal photopheresis ( ECP ) has been shown as active therapy for graft‐versus‐host disease ( GVHD ). Study Design and Methods The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD ( aGVHD and cGVHD ) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD . Results The overall response rate ( ORR ) for aGVHD was 65% and the complete aGVHD ‐free survival was 50% (95% confidence interval [ CI ], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD ‐free survival was 50% (95% CI , 34%‐73%). The aGVHD ‐free survival was associated with aGVHD grading ( G rade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD ‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the S eattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively. Conclusions While confirming a higher probability of GVHD responses for early GVHD , our study shows no role of hematologic values or apheresis cell count on GVHD response.