Extracorporeal photopheresis for graft-versus-host disease: the role of patient, transplant, and classification criteria and hematologic values on outcome-results from a large single-center study

BackgroundExtracorporeal photopheresis (ECP) has been shown as active therapy for graft-versus-host disease (GVHD). Study Design and MethodsThe aim was to ascertain the role of ECP in 71 patients with steroid-refractory or -dependent acute and chronic GVHD (aGVHD and cGVHD) with special focus on hematologic variables and GVHD staging classification. A total of 34 patients were treated for aGVHD and 37 for cGVHD. ResultsThe overall response rate (ORR) for aGVHD was 65% and the complete aGVHD-free survival was 50% (95% confidence interval [CI], 36%-70%). The ORR for cGVHD response was 81% while the complete cGVHD-free survival was 50% (95% CI, 34%-73%). The aGVHD-free survival was associated with aGVHD grading (GradeII 81%, GradeIII 33%, and GradeIV 0%, p0.00) and the absence of visceral involvement (77% vs. 33%, p=0.03). The cGVHD-free survival was associated with the female sex (67% vs. 25%, p=0.01) and with the limited form according to the Seattle classification (67% vs. 20%, p=0.003). No role for hematologic values or apheresis cell count was found, except for the cGVHD ORR (p=0.037). Transplant-related mortality and overall survival were associated with ECP response 0% versus 54% (p=0.0001) and 77% versus 45% (p=0.03) for aGVHD patients and 7% versus 14% (p=0.02) and 73% versus 20% (p=0.0003) for cGVHD patients, respectively. ConclusionsWhile confirming a higher probability of GVHD responses for early GVHD, our study shows no role of hematologic values or apheresis cell count on GVHD response.