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Blood, 1 October 2000, Vol. 96, No. 7, pp. 2426-2431
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Extracorporeal photochemotherapy in the treatment of severe
steroid-refractory acute graft-versus-host disease: a pilot
study
Hildegard T. Greinix,
Beatrix Volc-Platzer,
Peter Kalhs,
Gottfried Fischer,
Agatha Rosenmayr,
Felix Keil,
Hubert Hönigsmann, and
Robert M. Knobler
From the Department of Medicine I, Bone Marrow
Transplantation Unit, University of Vienna, Vienna, Austria; Department
of Dermatology, Division of Immunology, Allergy and Infectious
Diseases, University of Vienna, Vienna, Austria; Department of Blood
Group Serology, University of Vienna, Vienna, Austria; Department of
Dermatology, Division of Special and Environmental Dermatology,
University of Vienna, Vienna, Austria.
Extracorporeal exposure of peripheral blood mononuclear cells to
the photosensitizing agent 8-methoxypsoralen and UV-A radiation has
been shown to be effective in the treatment of selected diseases mediated by T cells, rejection after solid organ transplantation, and
chronic graft-versus-host disease (GVHD). We present 21 patients with a
median age of 38 years who developed steroid-refractory acute GVHD
grades II to IV after stem cell grafting from sibling or unrelated
donors and were referred to extracorporeal photochemotherapy (ECP).
Three months after initiation of ECP 60% of patients achieved a
complete resolution of GVHD manifestations. Complete responses were
obtained in 100% of patients with grade II, 67% of patients with
grade III, and 12% of patients with grade IV acute GVHD. Three
months after start of ECP complete responses were achieved in 60% of
patients with cutaneous, 67% with liver, and none with gut
involvement. Adverse events observed during ECP included a decrease in
peripheral blood cell counts in the early phase after stem cell
transplantation (SCT). Currently, 57% of patients are alive at a
median observation time of 25 months after SCT. Probability of survival
at 4 years after SCT is 91% in patients with complete response to ECP
compared to 11% in patients not responding completely. Our findings
suggest that ECP is an effective adjunct therapy for acute
steroid-refractory GVHD with cutaneous and liver involvement. However,
in patients with acute GVHD grade IV or gut involvement other
therapeutic options are warranted.
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