Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: Feasibility and results

N. Apisarnthanarax, M. Donato, M. Körbling, D. Couriel, J. Gajewski, S. Giralt, I. Khouri, C. Hosing, R. Champlin, M. Duvic, Paolo Anderlini

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98-8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12-98) over a median of 5.3 months (range 1-28), with a median of six sessions per month. The complete response (CR) rate was 22% (n = 7) and the partial response rate was 34% (n = 11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.

Original languageEnglish (US)
Pages (from-to)459-465
Number of pages7
JournalBone Marrow Transplantation
Volume31
Issue number6
DOIs
StatePublished - Mar 2003
Externally publishedYes

Fingerprint

Photopheresis
Stem Cell Transplantation
Graft vs Host Disease
Steroids
Skin
Therapeutics
Adrenal Cortex Hormones
Mycophenolic Acid
Tacrolimus

Keywords

  • Allogeneic stem cell transplantation
  • Chronic GVHD
  • Extracorporeal photopheresis
  • Graft-versus-host disease

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation : Feasibility and results. / Apisarnthanarax, N.; Donato, M.; Körbling, M.; Couriel, D.; Gajewski, J.; Giralt, S.; Khouri, I.; Hosing, C.; Champlin, R.; Duvic, M.; Anderlini, Paolo.

In: Bone Marrow Transplantation, Vol. 31, No. 6, 03.2003, p. 459-465.

Research output: Contribution to journalArticle

Apisarnthanarax, N. ; Donato, M. ; Körbling, M. ; Couriel, D. ; Gajewski, J. ; Giralt, S. ; Khouri, I. ; Hosing, C. ; Champlin, R. ; Duvic, M. ; Anderlini, Paolo. / Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation : Feasibility and results. In: Bone Marrow Transplantation. 2003 ; Vol. 31, No. 6. pp. 459-465.
@article{4fb868b8d05f4efa9f2a8324be8cca49,
title = "Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: Feasibility and results",
abstract = "We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98-8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34{\%}) being SR and 21 (66{\%}) SD. Cutaneous cGVHD was extensive in 28 patients (88{\%}) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72{\%}). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12-98) over a median of 5.3 months (range 1-28), with a median of six sessions per month. The complete response (CR) rate was 22{\%} (n = 7) and the partial response rate was 34{\%} (n = 11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50{\%} dose reduction while on ECP, yielding a 64{\%} steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34{\%}) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.",
keywords = "Allogeneic stem cell transplantation, Chronic GVHD, Extracorporeal photopheresis, Graft-versus-host disease",
author = "N. Apisarnthanarax and M. Donato and M. K{\"o}rbling and D. Couriel and J. Gajewski and S. Giralt and I. Khouri and C. Hosing and R. Champlin and M. Duvic and Paolo Anderlini",
year = "2003",
month = "3",
doi = "10.1038/sj.bmt.1703871",
language = "English (US)",
volume = "31",
pages = "459--465",
journal = "Bone Marrow Transplantation",
issn = "0268-3369",
publisher = "Nature Publishing Group",
number = "6",

}

TY - JOUR

T1 - Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation

T2 - Feasibility and results

AU - Apisarnthanarax, N.

AU - Donato, M.

AU - Körbling, M.

AU - Couriel, D.

AU - Gajewski, J.

AU - Giralt, S.

AU - Khouri, I.

AU - Hosing, C.

AU - Champlin, R.

AU - Duvic, M.

AU - Anderlini, Paolo

PY - 2003/3

Y1 - 2003/3

N2 - We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98-8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12-98) over a median of 5.3 months (range 1-28), with a median of six sessions per month. The complete response (CR) rate was 22% (n = 7) and the partial response rate was 34% (n = 11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.

AB - We conducted a retrospective analysis of all allogeneic stem cell transplantation (ASCT) patients started on extracorporeal photopheresis (ECP) for the management of steroid-dependent (SD) or steroid-refractory (SR) cutaneous chronic graft-versus-host disease (cGVHD) following ASCT during a 36-month period (9/98-8/01). Only SD or SR patients who were treated by ECP after day 100 and who received at least 4 weeks of ECP were considered evaluable for this analysis. Out of 64 ASCT patients reviewed, 32 patients met the inclusion criteria. All 32 patients had been previously treated with systemic corticosteroids with 11 (34%) being SR and 21 (66%) SD. Cutaneous cGVHD was extensive in 28 patients (88%) and was accompanied by visceral (hepatic, gastrointestinal) cGVHD in 23 patients (72%). The 32 evaluated patients had received a median of three prior therapies before ECP, most commonly systemic corticosteroids, tacrolimus, and mycophenolate mofetil. Patients received a median of 36 ECP sessions (range 12-98) over a median of 5.3 months (range 1-28), with a median of six sessions per month. The complete response (CR) rate was 22% (n = 7) and the partial response rate was 34% (n = 11). In all, 28 patients were on systemic corticosteroid therapy at ECP initiation and 18 patients achieved 50% dose reduction while on ECP, yielding a 64% steroid-sparing response rate. Of seven CRs, five are ongoing. A total of 11 (34%) patients have died after ECP, with all cases due to visceral cGVHD or cGVHD-related infectious complications. All 21 surviving patients remain on at least some immunosuppressive cGVHD therapy (including ECP in eight). Overall, ECP displays a substantial response rate and, in particular, steroid-sparing activity in SR/SD extensive cutaneous cGVHD. However, most patients continue to require at least some chronic therapy and cGVHD-related morbidity and mortality remain high.

KW - Allogeneic stem cell transplantation

KW - Chronic GVHD

KW - Extracorporeal photopheresis

KW - Graft-versus-host disease

UR - http://www.scopus.com/inward/record.url?scp=0242417628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0242417628&partnerID=8YFLogxK

U2 - 10.1038/sj.bmt.1703871

DO - 10.1038/sj.bmt.1703871

M3 - Article

C2 - 12665841

AN - SCOPUS:0242417628

VL - 31

SP - 459

EP - 465

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

SN - 0268-3369

IS - 6

ER -