Acute graft-versus-host disease (GVHD) remains a major problem following allogeneic hematopoietic stem cell transplantation (HSCT). Standard treatment typically includes corticosteroids and prophylaxis with a combination of therapeutic agents and immunosuppressants. For patients who do not respond to treatment and develop chronic GVHD, extracorporeal photopheresis (ECP) is an established treatment option.
In ECP, the patient’s blood is removed and separated into whole blood and buffy coats containing white blood cells and platelets. The blood is then chemically treated with 8-methoxypsoralen before being exposed to ultraviolet light. Finally, it is returned to the patient in a cytotoxic state that affects T-cell formation.
Despite its utility for chronic GVHD treatment, the efficacy of ECP for steroid-refractory acute GVHD is unknown.
In a study presented at the 2023 Tandem Meetings of ASTCT and CIBMTR, a team from the University of Miami, Miami, Florida, looked at the outcomes of patients at their institution who received ECP for steroid-refractory acute GVHD between January 2011 and September 2022. Their primary outcome was the overall response rate, but secondary outcomes included “reduction or discontinuation rate of CS and/or immunosuppressive therapy (IST) doses, reason(s) for discontinuation of ECP, and overall survival (OS) rate.”
Of the 27 patients who received ECP during the study’s timeframe, 12 had less than 8 ECP sessions and were thus considered not assessable. Of the remaining 15 patients, all were on concurrent immunosuppressive therapy, and 12 were on corticosteroids at the start of ECP. At the end of ECP, the overall response rate was 47% (n=7), and the overall survival at 6 months was 42%. Seven patients required increased immunosuppression, and 9 had a reduction in corticosteroid dosage during the treatment period.
“In the setting of aGvHD, ECP may be a steroid sparing agent. Efficacy is difficult due to use of combination IST and heterogeneous population, however survival in advanced/refractory aGvHD remain poor,” concluded the authors.
Diaz-Paez M, Mones K, Pereira D, et al. Outcomes in Patients Undergoing Extracorporeal Photopheresis (ECP) for Management of Acute Graft-Versus-Host Disease (GvHD). Abstract #362. Presented at the 2023 Tandem Meetings of ASTCT and CIBMTR; February 15-19, 2023; Orlando, FL.
