Extracorporeal photopheresis for treatment of chronic graft-versus-host disease

[摘要] Chronicgraft-versus-hostdisease(cGVHD)isthemostseriousandcommonlong-termcomplicationofallo-HSCT.Itisthemaincauseofnon-relapsemortalityandmorbidityinlong-termsurvivors.Inrecentyearsextracorporealphotopheresis(ECP)hasbeenusedasasecondlinetreatment:eitherincombinationwithotherimmunosuppressivedrugsoraloneinsteroid-dependentandrefractorycGVHD.Theaim:ToevaluatetheeffectivenessofECPforthetreatmentofcGVHDinpatientsafterallo-HSCT.Patientsandmethods:Twenty-fivepatients(15childrenandadolescents,10adults),agedfrom2to51y.o.(median22y)withALL(n=6),AML(n=9),MDS(n=2),CML(n=4),andotherdiagnoses(n=4)wereincludedinthestudy.Allptsreceivedallo-HSCT:fromunrelated(12pts(48%)),andrelated(13pts(52%))donors.ThetypeofcGVHDaccordingtoNIHcriteriawas:progressive:16pts(24%),quiescent:12pts(48%),denovo:5pts(20%),andoverlap:5pts(20%).Theresponsetocorticosteroidswasdependent(n=17),refractory(n=4),andintolerant(n=4).ECPtreatmentprotocolwas2timesevery2weeksor2timesevery4weeks.Patientsreceivedfrom1to20proceduresofECP(median8).Results:CompleteandpartialresolutionofcGVHDsignswasachievedin21pts(84%).Thedoseofcorticosteroidwasreducedorstoppedin53%pts.Abetterresponseratewasseeninskin(64%),gastro-intestinaltract(61%),oralmucosa(55%)andlung(50%)cGVHD.Conclusions:ECPisaneffectivemethodfortreatmentofsteroid-refractory,steroid-dependentandsteroid-intolerantcGVHD.

[学科分类] 肿瘤学

[关键词] allo-HSCT;cGVHD;extracorporeal photopheresis