Extracorporeal photopheresis for treatment of graft-versus-host disease

Cellular Therapy and Transplantation

Nina Worel¹  Zoya Kuzmina¹  Robert Knobler¹  Roman Weigl¹  Hildegard T. Greinix¹ 

关键词: graft-versus-host disease;    extracorporeal photopheresis;   

DOI  :  10.3205/ctt-2010-No9-abstract73

学科分类：肿瘤学

来源: Universitaetsklinikum Hamburg - Eppendorf / University Medical Center Hamburg - Eppendorf

【 摘 要 】

Graft-versus-hostdisease(GVHD)isaseriouscomplicationofallogeneichematopoieticcelltransplantation(HCT),andsteroid-refractoryGVHDpatientshaveadismalprognosis.Extracorporealphotopheresis(ECP)hasbeenusedworldwideformanyyearsfortreatmentofvariousTcellmediateddiseasesincludingcutaneousTcelllymphoma,preventionandtherapyofrejectionaftersolidorgantransplantation,andchronicGVHD.DuringECPthepatient’swhitebloodcellsarecollectedandincubatedwiththephotosensitizingagent8-Methoxypsoralen,irradiatedwithultravioletA,andre-transfusedintothepatient.ThemechanismsoftheactionofECPascurrentlyknownincludeinductionofapoptosisofallbloodcellsresultinginapronouncedanti-inflammatoryeffect,andinductionofregulatoryTcells,amongstothers.IntensifiedECPgiven2–3timesperweekachievedimpressiveresponseratesassalvagetherapyforsteroid-refractoryacuteGVHDwithcompleteresolutions(CR)in82%ofskin,61%ofliver,and61%ofgastrointestinalinvolvement.ECPhadasteroid-sparingeffectandCRpatientshadsignificantlylowerTRMandsignificantlyimprovedsurvival.Insteroid-refractorychronicGVHDECPresultsinallorgansincludingthesclerodermahavebeenverypromising.Inaprospective,randomized,phaseIIstudyinadvancedchronicGVHDECPhadasignificantsteroid-sparingeffectandsignificantlyincreasedcompleteandpartialresolutionsofskinmanifestationscomparedtoconventionaltreatment.ECPhasanexcellentsafetyprofileanddoesnotcausegeneralizedimmunosuppression.Thus,ECPishighlyefficaciousinbothacuteandchronicGVHDandshouldbefurtherinvestigatedinnewlydiagnosedGVHDanditsprevention.

【 授权许可】

Unknown