Extracorporeal Photopheresis versus Anticytokine Therapy as a Second-Line Treatment for Steroid-Refractory Acute GVHD: A Multicenter Comparative Analysis

被引：67
作者：
Jagasia, Madan [1 ]
Greinix, Hildegard [2 ]
Robin, Marie [3 ]
Das-Gupta, Emma [4 ]
Jacobs, Ryan [1 ]
Savani, Bipin N. [1 ]
Engelhardt, Brian G. [1 ]
Kassim, Adetola [1 ]
Worel, Nina [2 ]
Knobler, Robert [2 ]
Russel, Nigel [4 ]
Socie, Gerard [3 ]
机构：
[1] Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN 37232 USA
[2] Med Univ Vienna, Dept Internal Med 1, Vienna, Austria
[3] St Louis Hosp, Serv Hematol Greffe de Moelle, Paris, France
[4] Nottingham Univ Hosp NHS Trust, Univ Nottingham, Div Epidemiol & Publ Hlth, Nottingham, England
来源：
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2013年 / 19卷 / 07期
关键词：
Acute graft-versus-host disease; Steroid-refractory; Extracorporeal photopheresis; Allogeneic hematopoietic cell transplantation; VERSUS-HOST-DISEASE; MARROW; PREDNISONE; SURVIVAL; TERM;
D O I：
10.1016/j.bbmt.2013.04.018
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P < .001) were independent predictors of response. ECP therapy, adjusted for conditioning regimen intensity and steroid dose, was associated with superior survival-(hazard ratio [HR), 4.6; P = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P < .001) and lack of response to therapy (HR, 3.09; P = .011) were associated with inferior survival. These findings require validation in a prospective randomized study. (C) 2013 American Society for Blood and Marrow Transplantation.
引用
收藏
页码：1129 / 1133
页数：5
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