Extracorporeal photopheresis (ECP) is an established treatment strategy in steroid-refractory graft-versus-host disease (GVHD). This study's main objective was to analyze the clinical response and impact of ECP therapy in steroid dose reduction. A retrospective observational series of 113 patients from 7 transplantation centers was analyzed. Sixty-five patients (58%) had acute GVHD (aGVHD), and 48 (42%) had chronic GVHD (cGVHD). All ECP procedures were performed with the off-line system. The median number of procedures until achievement of initial response was 3 for both patients with aGVHD and those with cGVHD. ECP was the second-line therapy in 48% of the aGVHD cases and in 50% of the cGVHD cases. 71% of the cases of aGVHD were grade III-IV, and 69% of the cases of cGVHD were severe. The overall response rate on day 28 was 53% (complete response [CR] rate, 45%) in the patients with aGVHD and 67% (CR, 23%) in those with cGVHD. Skin was the most frequently involved organ, with a response rate of 58% (CR, 49%) in the patients with aGVHD and 69% (CR 29%) in those with cGVHD. At the end of ECP treatment, 60% of patients treated for aGVHD who responded were able to stop steroid therapy, with a median dose reduction of 100%. Significant differences in overall survival were observed for patients responding to ECP with aGVHD (hazard ratio [HR], 4.3; P < .001) and with cGVHD (HR, 4.8; P = .003). Our data indicate that ECP is a valid therapeutic alternative in patients with steroid-refractory aGVHD and cGVHD, permitting significant steroid dosage reductions.

中文翻译：

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甾体难治性急性和慢性移植物抗宿主病的体外光胆疗法的回顾性多中心研究。

体外光透疗法（ECP）是类固醇难治性移植物抗宿主病（GVHD）的既定治疗策略。这项研究的主要目的是分析ECP治疗对减少类固醇激素的临床反应和影响。回顾性观察系列来自7个移植中心的113例患者。急性GVHD（aGVHD）的患者为65名（58％），慢性GVHD（cGVHD）的患者为48名（42％）。所有ECP程序均通过离线系统执行。对于aGVHD患者和cGVHD患者，直到达到初始反应的平均过程数为3。在48％的aGVHD病例和50％的cGVHD病例中，ECP是二线治疗。aGVHD的71％为III-IV级，而cGVHD的69％为严重。在aGVHD患者中，第28天的总缓解率为53％（完全缓解[CR]率为45％），在cGVHD患者中为67％（CR，23％）。皮肤是受累最频繁的器官，aGVHD患者的缓解率为58％（CR，49％），而cGVHD患者的缓解率为69％（CR 29％）。在ECP治疗结束时，接受aGVHD治疗的60％有反应的患者能够停止类固醇治疗，中位剂量降低100％。对于aGVHD（危险比[HR]，4.3； P <.001）和cGVHD（HR，4.8； P = .003）对ECP应答的患者，观察到总体生存率存在显着差异。我们的数据表明，ECP在类固醇难治性aGVHD和cGVHD患者中是一种有效的治疗选择，可显着减少类固醇的剂量。23％的患者患有cGVHD。皮肤是受累最频繁的器官，aGVHD患者的缓解率为58％（CR，49％），而cGVHD患者的缓解率为69％（CR 29％）。在ECP治疗结束时，接受aGVHD治疗的60％有反应的患者能够停止类固醇治疗，中位剂量降低100％。对于aGVHD（危险比[HR]，4.3； P <.001）和cGVHD（HR，4.8； P = .003）对ECP应答的患者，观察到总体生存率存在显着差异。我们的数据表明，ECP在类固醇难治性aGVHD和cGVHD患者中是一种有效的治疗选择，可显着减少类固醇的剂量。有cGVHD的患者中占23％）。皮肤是受累最频繁的器官，aGVHD患者的缓解率为58％（CR，49％），而cGVHD患者的缓解率为69％（CR 29％）。在ECP治疗结束时，接受aGVHD治疗的60％有反应的患者能够停止类固醇治疗，中位剂量降低100％。对于aGVHD（危险比[HR]，4.3； P <.001）和cGVHD（HR，4.8； P = .003）对ECP应答的患者，观察到总体生存率存在显着差异。我们的数据表明，ECP在类固醇难治性aGVHD和cGVHD患者中是一种有效的治疗选择，可显着减少类固醇的剂量。接受过aGVHD治疗的患者中有60％能够停止类固醇治疗，中位剂量降低了100％。对于aGVHD（危险比[HR]，4.3； P <.001）和cGVHD（HR，4.8； P = .003）对ECP应答的患者，观察到总体生存率存在显着差异。我们的数据表明，ECP在类固醇难治性aGVHD和cGVHD患者中是一种有效的治疗选择，可显着减少类固醇的剂量。接受过aGVHD治疗的患者中有60％能够停止类固醇治疗，中位剂量降低了100％。对于aGVHD（危险比[HR]，4.3； P <.001）和cGVHD（HR，4.8； P = .003）对ECP应答的患者，观察到总体生存率存在显着差异。我们的数据表明，ECP在类固醇难治性aGVHD和cGVHD患者中是一种有效的治疗选择，可显着减少类固醇的剂量。