TY - JOUR
TI - Extracorporeal photopheresis in the treatment of chronic graft-versus-host disease. The Hellenic experience: A study by the Hellenic association of hematology
AU - Tsirigotis, P.
AU - Kaloyannidis, P.
AU - Papalexandri, A.
AU - Baltadakis, I.
AU - Karakasis, D.
AU - Batsis, I.
AU - Sakellari, I.
AU - Kitra, V.
AU - Goussetis, E.
AU - Papageorgiou, S.
AU - Spyridonidis, A.
AU - Graphakos, S.
AU - Harhalakis, N.
AU - Dervenoulas, I.
AU - Anagnostopoulos, A.
JO - Transfusion and Apheresis Science
PY - 2012
VL - 46
TODO - 2
SP - 173-180
PB - 
SN - 1473-0502
TODO - 10.1016/j.transci.2011.09.001
TODO - calcineurin inhibitor;  methotrexate;  mycophenolic acid 2 morpholinoethyl ester;  steroid;  thalidomide, adolescent;  adult;  article;  child;  chronic graft versus host disease;  disease severity;  drug withdrawal;  extracorporeal photopheresis;  female;  human;  immunosuppressive treatment;  major clinical study;  male;  mortality;  outcome assessment;  overall survival;  phototherapy;  preschool child;  relapse;  school child;  treatment duration;  treatment failure;  treatment response, Adolescent;  Adult;  Child;  Child, Preschool;  Chronic Disease;  Disease-Free Survival;  Female;  Graft vs Host Disease;  Hematology;  Humans;  Immunosuppression;  Incidence;  Male;  Middle Aged;  Neoplasms;  Photopheresis;  Retrospective Studies;  Societies, Medical;  Survival Rate
TODO - The Hellenic experience regarding the efficacy of extracorporeal photopheresis (ECP) in the treatment of 58 patients with chronic graft-versus-host disease (cGVHD) is presented in this article. All 58, except one patient, had failed at least one line of immunosuppressive treatment including steroids.Thirty-three out of 58 patients showed an objective overall response to ECP in a median time of 10. weeks after the onset of treatment. The cumulative incidence of overall response was 65.1%. In multivariate analysis, the presence of severe chronic GVHD was the only parameter associated with a significantly lower probability of response to treatment (RR=0.4, CI 95% 0.2-0.9, p=0.03). Responders to treatment with ECP were more likely to discontinue immunosuppression, had a lower probability of non-relapse mortality (RR=0.2, CI 95% 0.1-0.5, p=0.002), and a higher probability of overall survival (RR=7.8, CI 95% 3-20, p<. 0.001) in comparison with non-responders. Eight out of 58 patients experienced relapse of the original disease. The cumulative incidence of relapse in the group of responders to ECP was 6%, while it was 25% in the group of non-responders to ECP. In multivariate analysis, response to treatment with ECP was the only parameter statistically associated with a significantly decreased hazard of relapse (RR=0.1, CI 95% 0.1-0.7, p=0.02). ECP should be tested as first-line treatment in patients with cGVHD with the aim to minimize the duration of immunosuppression and the rate of relapse of the malignant disease. © 2011 Elsevier Ltd.
ER -