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Blood, 15 April 2006, Vol. 107, No. 8, pp. 3074-3080.
Prepublished online as a Blood First Edition Paper on December 20, 2005; DOI 10.1182/blood-2005-09-3907.
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CLINICAL TRIALS AND OBSERVATIONS
Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD
Daniel R. Couriel,
Chitra Hosing,
Rima Saliba,
Elizabeth J. Shpall,
Paolo Anderlini,
Beverly Rhodes,
Veronica Smith,
Issa Khouri,
Sergio Giralt,
Marcos de Lima,
Yvonne Hsu,
Shubhra Ghosh,
Joyce Neumann,
Borje Andersson,
Muzzafar Qazilbash,
Sharon Hymes,
Stella Kim,
Richard Champlin, and
Michele Donato
From the Departments of Blood and Marrow Transplantation, Dermatology, and Ophthalmology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Chronic graft-versus-host disease (GVHD) is a major limitation of successful allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal photochemotherapy (ECP) has been tested extensively in small cohorts of patients with chronic GVHD. In this study, we retrospectively evaluated 71 patients with severe chronic GVHD treated with ECP. Response rate was 61% (n = 43), and 14 patients had complete responses (CRs). The best responses were observed in skin, liver, oral mucosa, and eye. Factors affecting outcomes were assessed in the less heavily pretreated subgroup (n = 63). Thrombocytopenia was associated with a lower response rate (P = .04), and there was a trend toward a higher response rate in de novo chronic GVHD. At 6 months, a total of 27 (69%) of 39 patients who were alive continued to have a sustained response (CR 4 [10%] of 39, and partial response [PR] 23 [59%] of 39). The cumulative incidence of steroid discontinuation at 1 year was 22%. The overall survival since initiation of therapy was 53% at 1 year. Response to ECP and platelet count at initiation of therapy were the strongest predictors of nonrelapse mortality (NRM) on univariate analysis. Objective responses were observed in a substantial number of patients with both skin and visceral chronic GVHD failing corticosteroids and other immunosuppression.
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