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ctt-journal > Kozlov et al. (Abstract)

Kozlov et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract44

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Extracorporeal photopheresis in combined immunosuppressive treatment of acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

Andrey V. Kozlov, Tatyana A. Bykova, Sergey N. Shiryayev, Irina I. Kulagina, Evgeniya A. Kochina, Maria A. Estrina, Natalya V. Stancheva, Ludmila S. Zubarovskaya, Yuri  A. Punanov, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia

Correspondence: Andrey V. Kozlov, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str., St. Petersburg, 197022, Russia, E-mail: kozlovandrew@spam is badlist.ru

Abstract

Aim: To assess the efficiency of combined immunosuppressive therapy (IST) including extracorporeal photopheresis (ECP) for the steroid-refractory (SR) acute graft-versus-host disease (aGVHD) after allogeneic hematopoetic stem cell transplantation (allo-HSCT).

Methods: Seventeen patients (pts) with SR aGVHD were included in the study. All pts received ECP as a component of complex IST: combinations of calcineurin inhibitors/steroids/ECP in 5 pts, calcineurin inhibitors/steroids/MMF/ECP in 2 pts, calcineurin inhibitors/steroids/monoclonal antibodies/ECP in 9 pts, and calcineurin inhibitors/steroids/monoclonal antibodies/mesenchymal stem cells/ECP in 1 pt. Clinical characteristics of pts: 16 hematological malignancies, and one with Fanconi anemia; median age:16 years (range 3–39); and a median interval between allo-HSCT and ECP of 59 days (range 16–120). Functional Grading of aGVHD (Glucksberg): Grade I: 2 pts, Grade II: 1 pt, Grade III: 9 pts, and Grade IV: 5 pts. The schedule of ECP was individual, ranging from 1 to 2 procedures per week. The median number of ECP procedures was 5 (1–14).

Results: The overall response rate to combined IST with ECP was 59%, including complete response in 5 pts (29, 5%), and partial response in 5 pts (29, 5%). Seven patients (41%) did not respond. Response according to organ involvement is shown in table 1. Pts who responded had a 1-year overall survival of 100% and pts that didn’t respond had 1-year overall survival of 12% (p<0.001).

 Table1.

Response according to organ involvement

Skin (n=13)

Gut (n=7)

Liver (n=5)

Complete response

46.1 % (n=6)

28% (n=2)

20% (n=1)

Partial response

38.5% (n=5)

0%

0%

No response

15.4% (n=2)

72% (n=5)

80% (n=4)

Cell Ther Transplant. Vol. 3, No. 12. doi:10.3205/ctt-2011-No12-abstract44-table1


Conclusion:
Combined IST with ECP may be used for the treatment of SR aGVHD. The maximal effect is seen in aGVHD with skin involvement.

Keywords: acute graft-versus-host disease, steroid-refractory, extracorporeal photopheresis