Korean J Hematol.  2007 Dec;42(4):325-334. 10.5045/kjh.2007.42.4.325.

Effect of Extracorporeal Photopheresis on Steroid Resistant Acute GVHD Refractory to High Dose Steroid Treatment

• Kim SY
• Lee JW
• Min CK
• Cho BS
• Eom KS
• Kim YJ
• Lee S
• Kim HJ
• Cho SG
• Kim DW
• Min WS
• Kim CC

• KMID: 2252217
• DOI: http://doi.org/10.5045/kjh.2007.42.4.325

Abstract

BACKGROUND: The mortality of patients with steroid resistant acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) is high due to multiple organ failure and infection. Recently, the use of extracorporeal photopheresis (ECP), which is believed to have a low risk of infection, has been applied for the treatment of GVHD.
METHODS
Of 23 patients who were steroid resistant acute GVHD that was resistant even to high dose steroid treatment as second-line treatment, 10 patients received ECP (ECP group) and 13 patients received a third-line treatment other than ECP (non-ECP group). The outcome including the response rate and survival for the ECP group and non-ECP group was analyzed.
RESULTS
The response rate of the ECP group including complete remission and partial remission, was 30%. The survival rate was 30% for the ECP group and 0% for the non-ECP group. The estimated mean survival time was 229.3+/-89.3 days for the ECP group and 41.8+/-14.6 days for the non-ECP group (P=0.028).
CONCLUSION
ECP can be considered as a treatment option for the steroid resistant acute GVHD that is refractory to high dose steroid treatment.

Keyword

Steroid; Graft-versus-host disease; Hematopoietic stem cell transplantation; Extracorporeal photopheresis

MeSH Terms

Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Mortality
Multiple Organ Failure
Photopheresis*
Survival Rate

Figure

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  Fig. 1 Response to third-line treatment according to the organ type. The numbers in the parentheses indicate the number of affected patients. Abbreviations: See Table 1.

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  Fig. 2 Response to third-line treatment according to the acute GVHD grade. The numbers in the parentheses indicate the number of affected patients. Abbreviations: See Table 1.

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  Fig. 3 Overall survival of patients with steroid resistant acute graft-versus-host disease as determined by the type of third-line treatment (A), the response to third-line treatment (B) and platelet count (C). P values were determined by the log-rank test.

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