Τίτλος:
Extracorporeal photopheresis in the treatment of chronic graft-versus-host disease. The Hellenic experience: A study by the Hellenic association of hematology
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tsirigotis, P.
Kaloyannidis, P.
Papalexandri, A.
Baltadakis, I.
Karakasis, D.
Batsis, I.
Sakellari, I.
Kitra, V.
Goussetis, E.
Papageorgiou, S.
Spyridonidis, A.
Graphakos, S.
Harhalakis, N.
Dervenoulas, I.
Anagnostopoulos, A.
Περιοδικό:
Transfusion and Apheresis Science
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.transci.2011.09.001
