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Abstract
Background:
The mortality of patients with steroid resistant acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) is high due to multiple organ failure and infection. Recently, the use of extracorporeal photopheresis (ECP), which is believed to have a low risk of infection, has been applied for the treatment of GVHD.
Methods:
Of 23 patients who were steroid resistant acute GVHD that was resistant even to high dose steroid treatment as second-line treatment, 10 patients received ECP (ECP group) and 13 patients received a third-line treatment other than ECP (non-ECP group). The outcome including the response rate and survival for the ECP group and non-ECP group was analyzed.
Results:
The response rate of the ECP group including complete remission and partial remission, was 30%. The survival rate was 30% for the ECP group and 0% for the non-ECP group. The estimated mean survival time was 229.3±89.3 days for the ECP group and 41.8±14.6 days for the non-ECP group (P=0.028).
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Fig. 1
Response to third-line treatment according to the organ type. The numbers in the parentheses indicate the number of affected patients. Abbreviations: See Table 1.
Fig. 2
Response to third-line treatment according to the acute GVHD grade. The numbers in the parentheses indicate the number of affected patients. Abbreviations: See Table 1.
Fig. 3
Overall survival of patients with steroid resistant acute graft-versus-host disease as determined by the type of third-line treatment (A), the response to third-line treatment (B) and platelet count (C). P values were determined by the log-rank test.
Table 1.
Characteristics of 23 patients with steroid resistant acute GVHD who were treated with either extracorporeal photopheresis (ECP) or other treatment (non-ECP)
Abbreviations: ECP, extracorporeal photopheresis; non-ECP, third-line treatment other than extracorporeal photopheresis; SAA, severe aplastic anemia; AML, acute myeloid leukemia; ALL, acute lymphoblastic leukemia; MDS, myelodysplastic syndrome; CML, chronic myeloid leukemia; BM, bone marrow; PB, peripheral blood; DLI, donor lymphocyte infusion; GVHD, graft-versus-host disease; DI, documented infection; Tx, treatment; CMV, cytomegalovirus; LDH, lactate dehydrogenase.
Table 2.
Response to third-line treatment and survival of the patients with steroid resistant acute GVHD who were refractory to high dose steroid as an 2nd line treatment
Table 3.
Infection after third-line treatment in patients with steroid resistant acute GVHD
Table 4.
The indep survival of patients determined by mul pendent advers with steroid r tivariate analys se prognostic fa resistant acute sis actors for GVHD as
| Hazard ratio | 95 % C.I. | P value | |
|---|---|---|---|
| Platelet ＜50,000/mm3 | 14.342 | 1.313∼21.641 | 0.001 |
| Non-ECP | 5.343 | 1.670∼17.102 | 0.005 |
| Response ＜PR | 5.331 | 1.313∼21.641 | 0.019 |
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