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Greinix et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract73
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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Extracorporeal photopheresis for treatment of graft-versus-host disease

Hildegard T. Greinix1, Zoya Kuzmina1, Nina Worel2, Roman Weigl1, Robert Knobler3

1Department of Internal Medicine I, BMT, Medical University of Vienna, Austria; 2Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria; 3Department of Dermatology, Medical University of Vienna, Austria

Correspondence: Hildegard T. Greinix, MD, Medizinische Universitaet Vienna, Klinik fuer Innere Medizin I, KMT, Waehringer Guertel 18-20, A-1090 Vienna, Austria, E-mail: hildegard.greinix@spam is badmeduniwien.ac.at

Abstract

Graft-versus-host disease (GVHD) is a serious complication of allogeneic hematopoietic cell transplantation (HCT), and steroid-refractory GVHD patients have a dismal prognosis. Extracorporeal photopheresis (ECP) has been used worldwide for many years for treatment of various T cell mediated diseases including cutaneous T cell lymphoma, prevention and therapy of rejection after solid organ transplantation, and chronic GVHD. During ECP the patient’s white blood cells are collected and incubated with the photosensitizing agent 8-Methoxypsoralen, irradiated with ultraviolet A, and re-transfused into the patient. The mechanisms of the action of ECP as currently known include induction of apoptosis of all blood cells resulting in a pronounced anti-inflammatory effect, and induction of regulatory T cells, amongst others. Intensified ECP given 2–3 times per week achieved impressive response rates as salvage therapy for steroid-refractory acute GVHD with complete resolutions (CR) in 82% of skin, 61% of liver, and 61% of gastrointestinal involvement. ECP had a steroid-sparing effect and CR patients had significantly lower TRM and significantly improved survival. In steroid-refractory chronic GVHD ECP results in all organs including the scleroderma have been very promising. In a prospective, randomized, phase II study in advanced chronic GVHD ECP had a significant steroid-sparing effect and significantly increased complete and partial resolutions of skin manifestations compared to conventional treatment. ECP has an excellent safety profile and does not cause generalized immunosuppression. Thus, ECP is highly efficacious in both acute and chronic GVHD and should be further investigated in newly diagnosed GVHD and its prevention.

Keywords: graft-versus-host disease, extracorporeal photopheresis

 

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