What is the role of extracorporeal photopheresis (ECP) in the treatment of graft versus host disease (GVHD)?

Updated: Nov 21, 2016
  • Author: Vikas Shrivastava, MD; Chief Editor: William D James, MD  Dirk M Elston, MD  more...
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Answer

Answer

GVHD complicates the course of a large number of patients undergoing allogeneic hematopoietic stem cell transplantation, thus limiting the use of this potentially life-saving therapy. [15, 16, 17, 18, 19] GVHD is mediated by mature donor T cells within the infused graft and can affect multiple organ systems. [6] It is divided into an acute and a chronic disease, depending on whether it occurs within the first 100 days post transplantation or beyond.

While corticosteroids remain the standard initial treatment for both acute and chronic GVHD, ECP is a second-line therapy for steroid-refractory chronic GVHD, steroid-dependent chronic GVHD, steroid-refractory acute GVHD, and for patients intolerant of steroid therapy. [1, 6] In chronic GVHD, the use of ECP has been associated with overall response as high as 83%; greatest response has been evident in skin, mucous membrane, and GI/hepatic manifestations of disease. [1, 6, 20] Similar benefit has been seen in cutaneous, hepatic, and GI manifestations of acute GVHD. [20]

A retrospective study by Malagola et al of 94 patients with acute or chronic GVHD found that second-line therapy with ECP can induce a response rate of over 80%, with 29 of 45 of the study’s patients (64%) with acute GVHD still alive at median 20-month follow-up and 44 of 49 patients (90%) with chronic GVHD still alive at median 27-month follow-up. [21]

Interestingly, a 2010 study showed pretransplantation ECP demonstrated a significantly lower incidence of acute GVHD and higher disease-free and overall survival. [20] Further studies are underway exploring preventive use of ECP. [22]


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