Extracorporeal photopheresis in the management of steroid-refractory chronic graft-versus-host disease after allogeneic stem cell transplantation

Conventional intensified immunosuppressive therapy for refractory chronic graft-versus-host-disease (cGvHD) increases mortality and relapse rates after allogeneic hematopoietic cell transplantation. We retrospectively studied the efficacy and safety of extracorporeal photopheresis (ECP) in 44 patients with corticoid-resistant cGvHD. Thirty-seven patients received grafts from siblings and 7 from matched unrelated donors. Cyclosporine or tacrolimus and methotrexate ± ATG were administered as GvHD prophylaxis. Patients had received 2(1-4) lines of treatment for 13 months (median) before ECP. Ten patients had developed induced cGvHD post immunotherapy. Fifteen patients had mucocutaneous disease only, 9 cutaneous sclerosis manifestations, 13 visceral involvement and 7 patients skin sclerosis and liver. Patients completed a median number of 23 sessions of ECP/patient. The therapeutic schedule included 2 sessions per week for 1 month followed according to the severity of cGvHD, by either a) one session per week for 2 months and 1 per 15 days for 2 months or b) 1 session per 15 days for 4 months, and then both cohorts received 1 session per month for 4-8 months. Response was evaluated at 3 months and at the end of the treatment. Five patients died due to early complications (