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Pugachev et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract33
© 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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The use of extracorporeal photochemotherapy (ECP) for the treatment of chronic and acute GvHD. Experience of centre CIC 725 EBMT

Alexander A. Pugachev, Murad O. Yagmurov, Maria A. Estrina, Abdulbasyr A. Ganapiev, Boris V. Afanasyev

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

Correspondence: Alexander A. Pugachev, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Saint-Petersburg Pavlov State Medical University, 6/8, Tolstoy str., Saint-Petersburg, 197022, Russia, E-mail: pugachov@spam is badspmu.rssi.ru

Abstract

Hematopoietic Stem Cell Transplantation (HSCT) is the gold standard in the treatment of many diseases and the many experiences of its application are spreading now. Unfortunately, graft versus host disease (GVHD) still remains the leading cause of morbidity and mortality of patients after HSCT who have recovered from the underlying disease. The application of systemic immune suppression to treat GVHD often leads to significant mortality from infectious complications. Therefore, an effective and non-toxic method of selective immune modulation without total immune suppression, such as extracorporeal photochemotherapy, is finding wider application after transplantation.

Methods: Fourteen post-allogeneic HSCT patients were treated with 78 procedures of extracorporeal photochemotherapy by an “open system” (off-line) method. The collection of cells was performed by a Coba Spectra cell separator (Gambro Medical) and exposed to a Macogenic irradiation device (Macopharma) with the addition of 0.002% metoxypsoralen (8-MOP) to the target concentration of 200ng/ml at dose of 2.0–2.5 J/cm2. We analyzed our data of patients with acute and chronic GVHD treated with ECP in our center from December 2009 until June 2010. The median age was 30.5 years. Five patients were children and adolescents under 18 years, including 3 pts under 14 years. Men and women were divided 50/50%. The patient's diagnosis was as follows: AML, 5, ALL, 3, CML, 4, CLL, 1, and MDS, 1.

Results: In 10 patients with steroid-refractory chronic GVHD with skin and mucous involvements, ECP was performed at the rate of 2–4 procedures per month (2 consecutive days every 2–4 weeks), depending on the severity of clinical manifestations. In 2 cases we noted the involvement of the lungs with a clinically significant reduction in the residual lung capacity and expiratory peak flow rate as the development of bronchiolitis obliterans syndrome. One patient experienced liver involvement. The number of irradiations varied from 2 to 12, or 5.9 per patient on average. All patients responded to ECP therapy. 7 patients (70%) had a partial response, and in 3 (30%) cases a stabilization of disease enabled the possibility of reduction in steroid dose to 50% or complete termination. Nobody died during treatment in this group.

4 patients with acute GVHD involving the skin, gastrointestinal tract, and liver received from 1 to 2 ECP procedures. By schedule one procedure was performed weekly until a clinical result with steroid and total immune suppression therapy. The best effect was achieved in all patients with GVHD with skin and mucous involvement. One boy with acute GVHD of the skin and eyes had complete regression of clinical manifestations and the reduction of steroids during the week. The use of ECP in acute GVHD of the intestinal and liver has not led to any reliable effects. Both patients died from multiple organ failure with clinical signs of intestinal GVHD grade 3–4.

Statistical data of lymphocytes populations and cytokine level in our limited group of patients showed no statistically significant associations. All procedures were safe for patients with laboratory results and bacteriological control.

Conclusion: Our preliminary experience demonstrates that ECP is safe and efficacious method in GVHD treatment.

Keywords: ECP, GVHD treatment

 

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