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Prepublished online as a Blood First Edition Paper on April 24, 2003; DOI 10.1182/blood-2002-11-3351.
Submitted November 6, 2002
Accepted April 6, 2003
Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response
Edward D Seaton*, Richard M Szydlo, Edward Kanfer, Jane F Apperley, and Robin Russell-Jones
Department of Dermatology, Hammersmith Hospital Campus, Imperial College, London, United Kingdom
Skin Tumour Unit, St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
Department of Haematology, Hammersmith Hospital Campus, Imperial College, London, United Kingdom
* Corresponding author; email: edseaton{at}doctors.org.uk.
We report 28 patients with advanced chronic graft-versus-host disease (cGVHD) treated with extracorporeal photopheresis (ECP). All had failed conventional immunosuppressive therapy. 27 patients had extensive cGVHD and 20 had over 50% cutaneous surface area involvement. ECP was initiated approximately 2 years after onset of cGVHD and 3 years following allogeneic stem cell transplantation and administered fortnightly for 4 months and then monthly. Response was assessed using quantifiable disease measures, including skin score, liver function tests (LFTs), blood counts and lung function tests. Regression analysis allowed assessment of any pretreatment clinical or laboratory parameters that predicted response. 25 patients completed 3 months' and 21 completed 6 months' treatment. Systemic immunosuppression was stable or reduced in 86%. Three patients died from cGVHD. After 6 months, median skin scores were 53% lower (p=0.003) in sclerodermoid and lichenoid disease. 3 of 6 patients with mucosal ulceration improved. A non-significant improvement of LFTs occurred. We infer that ECP is effective even in patients with extensive cutaneous cGVHD of 2 years duration that is resistant to conventional therapy. Furthermore both sclerodermoid and lichenoid subtypes responded. However, no baseline parameters predicted a favourable response to ECP, so patient selection must continue to be made on clinical grounds.
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