Extracorporeal photopheresis as first line strategy in the treatment of acute graftversus-host disease after haematopoietic stem cell transplantation: a single centre experience - Sorbonne Université
Article Dans Une Revue Cytotherapy Année : 2020

Extracorporeal photopheresis as first line strategy in the treatment of acute graftversus-host disease after haematopoietic stem cell transplantation: a single centre experience

Résumé

Background aims: Corticosteroids are the standard first-line treatment for acute graft-versus-host disease (aGVHD), but they are associated with many complications, and less than half of patients have a sustained response. Methods: To improve outcomes, we performed a retrospective study to analyze the efficacy of the addition of extracorporeal photopheresis (ECP) to low-dose corticosteroids in 37 adult patients (median age, 57 years) with skin-predominant aGVHD (grade I, n = 17; grade II, n = 18; and grade III, n = 2). All patients received ECP in combination with 1 mg/kg prednisone (n = 26) or topical steroids (n = 11). Results: Overall response rate was 81% after a median of three ECP procedures (range, 2–8), including 22 complete responses (CR, 59%) and eight very good partial responses (VGPR, 22%). The 11 patients treated with topical corticosteroids achieved CR. Furthermore, 16 (62%) patients reached prednisone withdrawal at a median of 100 days (range, 42–174 days) after its initiation. Eighteen patients developed chronic GVHD (cGVHD); 11 of them (who were in CR of aGVHD) had a new-onset cGVHD, and seven experienced progressive cGVHD (five non-responding and two VGPR patients). A second-line immunosuppressive treatment was initiated in only five (14%) non-responding patients. With a median follow-up of 31 months (range, 6–57 months) 2-year overall survival and non-relapse mortality were 74% and 11%, respectively. Conclusions: Overall, the combination of low-dose corticosteroids and ECP appear to be safe and effective for first-line treatment of skin predominant aGVHD.

Domaines

Hématologie
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Dates et versions

hal-03145941 , version 1 (18-02-2021)

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Simona Sestili, Sandra Eder, Ramdane Belhocine, Rémy Duléry, Giorgia Battipaglia, et al.. Extracorporeal photopheresis as first line strategy in the treatment of acute graftversus-host disease after haematopoietic stem cell transplantation: a single centre experience. Cytotherapy, 2020, 22 (8), pp.445-449. ⟨10.1016/j.jcyt.2020.03.003⟩. ⟨hal-03145941⟩
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