Extracorporeal photopheresis in the treatment of acute graft‐versus‐host disease: a single‐center experience

BACKGROUND Steroid‐refractory acute graft‐versus‐host disease (aGVHD) is a serious complication after hematopoietic stem cell transplantation. The long‐term outcome of the patients is poor. Various immunosuppressive agents have been proposed as the second‐line therapy but none of them has turned out more effective than the others. Extracorporeal photopheresis (ECP) is a treatment option that does not predispose the patients to severe side effects of the immunosuppressive drugs. STUDY DESIGN AND METHODS We analyzed the treatment results of ECP in 52 patients with steroid‐refractory or steroid‐dependent aGVHD. Eighty‐one percent of the patients suffered from a severe, Grade III or IV, aGVHD. ECP was started alone as the second‐line treatment in 23 patients and in combination with an immunosuppressive drug in 18 patients. Eleven patients received ECP as the third‐line or later treatment. RESULTS A total of 62% of the patients responded, with 48% achieving complete response. In the patients with complete or partial response, the probabilities of survival at 4 years were 54 and 17%, respectively. The outcome of nonresponders was poor. The 1‐year overall survivals of the patients with ECP as the second‐line treatment either alone or in combination with an immunosuppressive drug or as the third‐line treatment were 51, 28, and 18%, respectively. In multivariate analysis, starting ECP no later than 10 days after the start of the first‐line treatment correlated with a good response and a consequent survival benefit. CONCLUSION Extracorporeal photopheresis is an effective and well‐tolerated treatment that should be considered as a second‐line treatment for aGVHD.