Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study
Background Extracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD). Study Design and Methods The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on h...
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| Veröffentlicht in: | Transfusion (Philadelphia, Pa.) Pa.), 2015-04, Vol.55 (4), p.736-747 |
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| creator | Berger, Massimo Albiani, Roberto Sini, Bruno Fagioli, Franca |
| description | Background
Extracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD).
Study Design and Methods
The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.
Results
The overall response rate (ORR) for aGVHD was 65% and the complete aGVHD‐free survival was 50% (95% confidence interval [CI], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD‐free survival was 50% (95% CI, 34%‐73%). The aGVHD‐free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.
Conclusions
While confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response. |
| doi_str_mv | 10.1111/trf.12900 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4403977</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3649059711</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4810-de56c31ff94cca4f77779e67e61e640230a3fd23fd24313fe3279f12d4122c033</originalsourceid><addsrcrecordid>eNp1kt9qFDEUxgdR7Fq98AUk4I2C0-bPTOL0QpDabYVFQStehpg52UnNTMYks3afzxcz020XFTwQEji_fOc7ySmKpwQfkRzHKZgjQhuM7xULUjNR0qap7xcLjCtSEsLoQfEoxiuMcYbIw-KA1qyued0sil9n1yko7cPoAyiHxs4nP3YQINqIjA9oHZRJ5QZCnGLZ-ZhQayOoCCcodYCCd4C8QaNKFob0CmW5IY5OzWc1tEg7FaM1VmfAD0gHmyBYdZProFfJO7-2Gm2UmyCijPgpad9DmT1MLmUXwfdIIafCGlC0w9pBqXMtCCimqd0-Lh4Y5SI8ud0Piy_Ls8vTi3L18fz96dtVqavXBJct1FwzYkxTaa0qI3I0wAVwArzClGHFTEvnVTHCDDAqGkNoWxFKNWbssHiz0x2nbz20s4WgnByD7VXYSq-s_Dsz2E6u_UZWFWaNEFngxa1A8D9ys0n2Nmpw-bHAT1ESwWnD8zfNtZ7_g175KQy5PUm4IKThXFSZermjdPAxBjB7MwTLeTRkHg15MxqZffan-z15NwsZON4BP62D7f-V5OWn5Z1kubthY4Lr_Q0VvksumKjl1w_n8oIvBW7efZYr9hvwHNfZ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1671196674</pqid></control><display><type>article</type><title>Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Berger, Massimo ; Albiani, Roberto ; Sini, Bruno ; Fagioli, Franca</creator><creatorcontrib>Berger, Massimo ; Albiani, Roberto ; Sini, Bruno ; Fagioli, Franca</creatorcontrib><description>Background
Extracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD).
Study Design and Methods
The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.
Results
The overall response rate (ORR) for aGVHD was 65% and the complete aGVHD‐free survival was 50% (95% confidence interval [CI], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD‐free survival was 50% (95% CI, 34%‐73%). The aGVHD‐free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.
Conclusions
While confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.</description><identifier>ISSN: 0041-1132</identifier><identifier>EISSN: 1537-2995</identifier><identifier>DOI: 10.1111/trf.12900</identifier><identifier>PMID: 25355659</identifier><identifier>CODEN: TRANAT</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Aged ; Biomarkers ; Blood Group Incompatibility - epidemiology ; Bone Marrow Transplantation - adverse effects ; Child ; Child, Preschool ; Classification ; Combined Modality Therapy ; Confidence intervals ; Cord Blood Stem Cell Transplantation - adverse effects ; Drug Resistance ; Female ; Graft vs Host Disease - blood ; Graft vs Host Disease - drug therapy ; Graft vs Host Disease - prevention & control ; Graft vs Host Disease - therapy ; Hemapheresis ; Hematologic Neoplasms - blood ; Hematologic Neoplasms - therapy ; Humans ; Immunosuppressive Agents - therapeutic use ; Male ; Middle Aged ; Mortality ; Peripheral Blood Stem Cell Transplantation - adverse effects ; Photopheresis ; Prospective Studies ; Survival Analysis ; Transplantation Conditioning ; Treatment Outcome</subject><ispartof>Transfusion (Philadelphia, Pa.), 2015-04, Vol.55 (4), p.736-747</ispartof><rights>2014 The Authors. Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.</rights><rights>2015 AABB</rights><rights>2014 The Authors. Transfusion published by Wiley Periodicals, Inc. on behalf of AABB. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4810-de56c31ff94cca4f77779e67e61e640230a3fd23fd24313fe3279f12d4122c033</citedby><cites>FETCH-LOGICAL-c4810-de56c31ff94cca4f77779e67e61e640230a3fd23fd24313fe3279f12d4122c033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftrf.12900$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftrf.12900$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,315,781,785,886,1418,27928,27929,45578,45579</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25355659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berger, Massimo</creatorcontrib><creatorcontrib>Albiani, Roberto</creatorcontrib><creatorcontrib>Sini, Bruno</creatorcontrib><creatorcontrib>Fagioli, Franca</creatorcontrib><title>Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study</title><title>Transfusion (Philadelphia, Pa.)</title><addtitle>Transfusion</addtitle><description>Background
Extracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD).
Study Design and Methods
The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.
Results
The overall response rate (ORR) for aGVHD was 65% and the complete aGVHD‐free survival was 50% (95% confidence interval [CI], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD‐free survival was 50% (95% CI, 34%‐73%). The aGVHD‐free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.
Conclusions
While confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.</description><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers</subject><subject>Blood Group Incompatibility - epidemiology</subject><subject>Bone Marrow Transplantation - adverse effects</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Classification</subject><subject>Combined Modality Therapy</subject><subject>Confidence intervals</subject><subject>Cord Blood Stem Cell Transplantation - adverse effects</subject><subject>Drug Resistance</subject><subject>Female</subject><subject>Graft vs Host Disease - blood</subject><subject>Graft vs Host Disease - drug therapy</subject><subject>Graft vs Host Disease - prevention & control</subject><subject>Graft vs Host Disease - therapy</subject><subject>Hemapheresis</subject><subject>Hematologic Neoplasms - blood</subject><subject>Hematologic Neoplasms - therapy</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Peripheral Blood Stem Cell Transplantation - adverse effects</subject><subject>Photopheresis</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>Transplantation Conditioning</subject><subject>Treatment Outcome</subject><issn>0041-1132</issn><issn>1537-2995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kt9qFDEUxgdR7Fq98AUk4I2C0-bPTOL0QpDabYVFQStehpg52UnNTMYks3afzxcz020XFTwQEji_fOc7ySmKpwQfkRzHKZgjQhuM7xULUjNR0qap7xcLjCtSEsLoQfEoxiuMcYbIw-KA1qyued0sil9n1yko7cPoAyiHxs4nP3YQINqIjA9oHZRJ5QZCnGLZ-ZhQayOoCCcodYCCd4C8QaNKFob0CmW5IY5OzWc1tEg7FaM1VmfAD0gHmyBYdZProFfJO7-2Gm2UmyCijPgpad9DmT1MLmUXwfdIIafCGlC0w9pBqXMtCCimqd0-Lh4Y5SI8ud0Piy_Ls8vTi3L18fz96dtVqavXBJct1FwzYkxTaa0qI3I0wAVwArzClGHFTEvnVTHCDDAqGkNoWxFKNWbssHiz0x2nbz20s4WgnByD7VXYSq-s_Dsz2E6u_UZWFWaNEFngxa1A8D9ys0n2Nmpw-bHAT1ESwWnD8zfNtZ7_g175KQy5PUm4IKThXFSZermjdPAxBjB7MwTLeTRkHg15MxqZffan-z15NwsZON4BP62D7f-V5OWn5Z1kubthY4Lr_Q0VvksumKjl1w_n8oIvBW7efZYr9hvwHNfZ</recordid><startdate>201504</startdate><enddate>201504</enddate><creator>Berger, Massimo</creator><creator>Albiani, Roberto</creator><creator>Sini, Bruno</creator><creator>Fagioli, Franca</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><general>BlackWell Publishing Ltd</general><scope>BSCLL</scope><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201504</creationdate><title>Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study</title><author>Berger, Massimo ; Albiani, Roberto ; Sini, Bruno ; Fagioli, Franca</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4810-de56c31ff94cca4f77779e67e61e640230a3fd23fd24313fe3279f12d4122c033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Biomarkers</topic><topic>Blood Group Incompatibility - epidemiology</topic><topic>Bone Marrow Transplantation - adverse effects</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Classification</topic><topic>Combined Modality Therapy</topic><topic>Confidence intervals</topic><topic>Cord Blood Stem Cell Transplantation - adverse effects</topic><topic>Drug Resistance</topic><topic>Female</topic><topic>Graft vs Host Disease - blood</topic><topic>Graft vs Host Disease - drug therapy</topic><topic>Graft vs Host Disease - prevention & control</topic><topic>Graft vs Host Disease - therapy</topic><topic>Hemapheresis</topic><topic>Hematologic Neoplasms - blood</topic><topic>Hematologic Neoplasms - therapy</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Peripheral Blood Stem Cell Transplantation - adverse effects</topic><topic>Photopheresis</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>Transplantation Conditioning</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berger, Massimo</creatorcontrib><creatorcontrib>Albiani, Roberto</creatorcontrib><creatorcontrib>Sini, Bruno</creatorcontrib><creatorcontrib>Fagioli, Franca</creatorcontrib><collection>Istex</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transfusion (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berger, Massimo</au><au>Albiani, Roberto</au><au>Sini, Bruno</au><au>Fagioli, Franca</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study</atitle><jtitle>Transfusion (Philadelphia, Pa.)</jtitle><addtitle>Transfusion</addtitle><date>2015-04</date><risdate>2015</risdate><volume>55</volume><issue>4</issue><spage>736</spage><epage>747</epage><pages>736-747</pages><issn>0041-1132</issn><eissn>1537-2995</eissn><coden>TRANAT</coden><abstract>Background
Extracorporeal photopheresis (ECP) has been shown as active therapy for graft‐versus‐host disease (GVHD).
Study Design and Methods
The aim was to ascertain the role of ECP in 71 patients with steroid‐refractory or ‐dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD.
Results
The overall response rate (ORR) for aGVHD was 65% and the complete aGVHD‐free survival was 50% (95% confidence interval [CI], 36%‐70%). The ORR for cGVHD response was 81% while the complete cGVHD‐free survival was 50% (95% CI, 34%‐73%). The aGVHD‐free survival was associated with aGVHD grading (Grade II 81%, Grade III 33%, and Grade IV 0%, p ≤ 0.00) and the absence of visceral involvement (77% vs. 33%, p = 0.03). The cGVHD‐free survival was associated with the female sex (67% vs. 25%, p = 0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p = 0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p = 0.037). Transplant‐related mortality and overall survival were associated with ECP response 0% versus 54% (p = 0.0001) and 77% versus 45% (p = 0.03) for aGVHD patients and 7% versus 14% (p = 0.02) and 73% versus 20% (p = 0.0003) for cGVHD patients, respectively.
Conclusions
While confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25355659</pmid><doi>10.1111/trf.12900</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adolescent Adrenal Cortex Hormones - therapeutic use Adult Aged Biomarkers Blood Group Incompatibility - epidemiology Bone Marrow Transplantation - adverse effects Child Child, Preschool Classification Combined Modality Therapy Confidence intervals Cord Blood Stem Cell Transplantation - adverse effects Drug Resistance Female Graft vs Host Disease - blood Graft vs Host Disease - drug therapy Graft vs Host Disease - prevention & control Graft vs Host Disease - therapy Hemapheresis Hematologic Neoplasms - blood Hematologic Neoplasms - therapy Humans Immunosuppressive Agents - therapeutic use Male Middle Aged Mortality Peripheral Blood Stem Cell Transplantation - adverse effects Photopheresis Prospective Studies Survival Analysis Transplantation Conditioning Treatment Outcome |
| title | Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study |
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