Extracorporeal Photopheresis (ECP) for Acute and Chronic GVHD, a Report of 56 Patients Treated in a Single Institution.

Acute and chronic GvHD remain the leading cause of morbidity and mortality of allogenic stem cells transplantation. Immunosuppressive therapy is the mainstay of prophylaxis and therapy for GvHD; however, it heavily impacts on post transplant morbidity and mortality and new modalities are continually needed. Reported here is the five-year experience in a single institution of ECP for acute and chronic GvHD patients. Mononuclear cells were collected using Cobe -Spectra version 7 manual operation for adults and version 6 for pediatric patients. 1.5–2.0 blood volumes were circulated through the cell separator with a product of approximately 5X10⁹ mononuclear cells. When product hematocrit was less then 3%, volume was added to 300ml. With plasmacyte electrolyte solution and when the hematocrit was more then 3%, volume was added to 500 ml. 8 methoxy psoralen (8MOP) was added to a final concentration of 0.2ug/ml. Cells were then transferred to irradiation bag, exposed to 2 Joule /cm2 of UVA (365nM) (Biogenetic Vilber Lourmat) and re-transfused. The treatment protocol consisted of 2 consecutive ECP performed at bi-weekly intervals until clinical improvement. Fifty-six patients, 34 males and 22 females, age 1 to 64y (median 31 years), were treated. Patients underwent allogeneic bone marrow transplantation for the following indications. AML -21, ALL- 19, CML-8, Thalassemia 4, MDS-2, MM-1 NHL-1. Sixteen were treated for acute GvHD and 40 for chronic GvHD. Diffuse GvHD of skin was diagnosed in 43, gastro-intestinal tract 10; joint involvement 12, and liver involvement 35 patients. Patients had from 4 to 66 ECP (median 21). Results: 15 pts succumbed,10 with acute GvHD and 5 with chronic GvHD. Disease relapse was the cause of death in two patients with acute GvHD. Overall response rate was 46/56 (82%). Response rate for chronic GvHD was 37/40 (92%) and for acute GvHD was 9/16 (56%). Complete resolution of GvHD, partial response and no response were seen respectively in 33%, 60%, 7% for patients with chronic GvHD and 0%, 56% and 44% for patients with acute GvHD. Conclusions: ECP is a useful therapeutic modality for GvHD and is most effective in patients with chronic GvHD. It is most effective for both liver and skin involvement and less effective for patients with scleroderma. It is suggested that this modality should be used in early management of these patients concomitantly with immune suppressive therapy in the order to improve quality of life and reduce long-term side effects.