Extracorporeal Photopheresis in SR aGVHD Treatment

By Patrick Daly - Last Updated: November 16, 2022

Steroid-refractory (SR) active graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem-cell transplant (HCT) in patients with hematological malignancies. Extracorporeal photopheresis (ECP), a process of collecting blood and altering separated-out white blood cells, is a novel therapy that has shown promise in treating GVHD with minimal toxicity.

ECP Improves Overall Survival in HCT Recipients

In a study, published in Bone Marrow Transplantation, researchers evaluated patients who underwent allogeneic HCT and found that ECP was associated with improved overall survival (OS).

The study included 103 retrospective patients with SR aGVHD. Of those patients, 79 received ECP and 24 did not. Baseline aGVHD grades and total organ involvement at onset of aGVHD and treatment initiation were comparable between the groups, the authors added.

Of note, researchers reported patients in the ECP group had improved OS (P=.01), disease- free survival (P=.008), lower relapse (P=.05), similar nonrelapse mortality, and shorter hospital stays in the 180 days following aGVHD onset (20 vs 38; P=.03) compared with patients who did not receive ECP.

Variables influencing OS included:

  • CMV positive versus CMV negative (hazard ratio [HR], 2.34; 95% CI, 1.16-4.69)
  • Myeloablative versus nonmyeloablative conditioning (HR, 0.39; 95% CI, 0.20-0.75)
  • Use of ECP versus no ECP (HR, 0.39; 95% CI, 0.20-0.75)

“The use of ECP in the treatment of SR aGVHD results in improved overall survival secondary to lower relapse rates compared with other therapeutic modalities that do not incorporate ECP,” the authors summarized.

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