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Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3098-3104
Successful Use of Extracorporeal Photochemotherapy in the Treatment
of Severe Acute and Chronic Graft-Versus-Host Disease
Hildegard T. Greinix,
Beatrix Volc-Platzer,
Werner Rabitsch,
Bernd Gmeinhart,
Carlos Guevara-Pineda,
Peter Kalhs,
Jean Krutmann,
Herbert Hönigsmann,
Marina Ciovica, and
Robert M. Knobler
From the Department of Medicine I, Bone Marrow Transplantation Unit,
the Department of Dermatology, Division of Immunology, Allergy and
Infectious Diseases, and the Department of Dermatology, Division of
Special and Environmental Dermatology, University of Vienna, Vienna,
Austria; and the Department of Dermatology, Division of Clinical and
Experimental Dermatology, Heinrich-Heine-University of Duesseldorf,
Duesseldorf, Germany.
Extracorporeal exposure of peripheral blood mononuclear cells to the
photosensitizing compound 8-methoxypsoralen and ultraviolet A radiation
has been shown to be effective in the treatment of several
T-cell-mediated diseases, including cutaneous T-cell lymphoma and
rejection after organ transplantation. We present 21 patients (10 men
and 11 women) with hematological malignancies with a median age of 36 years (range, 25 to 55 years) who had received marrow grafts from
sibling (n = 12) or unrelated (n = 9) donors. Six patients had
acute graft-versus-host disease (GVHD) grade II to III not responding
to cyclosporine A (CSA) and prednisolone when referred to
extracorporeal photochemotherapy (ECP). In 15 patients, 2 to 24 months
after bone marrow transplantation (BMT), extensive chronic GVHD with
involvement of skin (n = 15), liver (n = 10), oral mucosa
(n = 11), ocular glands (n = 6), and thrombocytopenia (n = 3)
developed and was unresponsive to conventional therapy, including
steroids. All patients were treated with ECP on 2 consecutive days
every 2 weeks for the first 3 months and thereafter every 4 weeks until
resolution of GVHD. ECP was tolerated excellently without any
significant side effects. After a median of 14 cycles of ECP, acute
GVHD resolved completely in 4 of 6 patients (67%) and partially in
another 2 patients. Cutaneous chronic GVHD completely resolved in 12 of
15 (80%) patients. Contractures of knees and elbows due to scleroderma
resolved partially. Oral mucosal ulcerations resolved in all patients.
Seven of 10 patients (70%) with liver involvement had complete
responses after ECP. After discontinuation of ECP, no severe infections
were observed. Our findings suggest that ECP is a safe and effective
adjunct therapy for both acute and extensive chronic GVHD with skin and
visceral involvement and resistance to conventional therapy.
© 1998 by The American Society of Hematology.
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