Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease.

Abstract

Extracorporeal exposure of peripheral blood mononuclear cells to the photosensitizing compound 8-methoxypsoralen and ultraviolet A radiation has been shown to be effective in the treatment of several T-cell-mediated diseases, including cutaneous T-cell lymphoma and rejection after organ transplantation. We present 21 patients (10 men and 11 women) with hematological malignancies with a median age of 36 years (range, 25 to 55 years) who had received marrow grafts from sibling (n = 12) or unrelated (n = 9) donors. Six patients had acute graft-versus-host disease (GVHD) grade II to III not responding to cyclosporine A (CSA) and prednisolone when referred to extracorporeal photochemotherapy (ECP). In 15 patients, 2 to 24 months after bone marrow transplantation (BMT), extensive chronic GVHD with involvement of skin (n = 15), liver (n = 10), oral mucosa (n = 11), ocular glands (n = 6), and thrombocytopenia (n = 3) developed and was unresponsive to conventional therapy, including steroids. All patients were treated with ECP on 2 consecutive days every 2 weeks for the first 3 months and thereafter every 4 weeks until resolution of GVHD. ECP was tolerated excellently without any significant side effects. After a median of 14 cycles of ECP, acute GVHD resolved completely in 4 of 6 patients (67%) and partially in another 2 patients. Cutaneous chronic GVHD completely resolved in 12 of 15 (80%) patients. Contractures of knees and elbows due to scleroderma resolved partially. Oral mucosal ulcerations resolved in all patients. Seven of 10 patients (70%) with liver involvement had complete responses after ECP. After discontinuation of ECP, no severe infections were observed. Our findings suggest that ECP is a safe and effective adjunct therapy for both acute and extensive chronic GVHD with skin and visceral involvement and resistance to conventional therapy.

• Authors: H T Greinix, B Volc-Platzer, W Rabitsch, B Gmeinhart, C Guevara-Pineda, P Kalhs, J Krutmann, H Hönigsmann, M Ciovica, R M Knobler
• Journal: Blood (Blood) Vol. 92 Issue 9 Pg. 3098-104 (Nov 01 1998) ISSN: 0006-4971 [Print] United States
• PMID: 9787144 (Publication Type: Journal Article)
• Copyright: Copyright 1998 by The American Society of Hematology

Topics

• Acute Disease
• Adult
• Anemia, Aplastic (therapy)
• Bone Marrow Transplantation (adverse effects)
• Chronic Disease
• Female
• Graft vs Host Disease (drug therapy, mortality)
• Hematologic Neoplasms (therapy)
• Humans
• Immunosuppression Therapy (methods)
• Infections (epidemiology)
• Life Tables
• Male
• Middle Aged
• Photopheresis
• Skin (pathology)
• Survival Analysis
• Treatment Outcome