Extracorporeal photopheresis (ecp) for treatement of acute and chronic graft versus host disease : an Italian multicentric retrospective analysis on 94 patients on behalf of the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

BACKGROUND: Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD). METHODS: Ninety-four patients with aGVHD (n=45) and cGVHD (n=49), retrospectively recruited in 6 Italian Centers, were submitted to ECP for second-line treatment. At the time of ECP, 22 (49%) and 23 (51%) out of 45 patients with aGHVD were non responsive (NR) and in partial remission (PR) after steroids, respectively, and all the 49 patients with cGVHD were steroid refractory. RESULTS: Forty-one out of 45 (91%) patients with aGVHD achieved complete remission (CR) after ECP. Fifteen out of 45 (33%) patients developed cGVHD. The CR rate in patients who started ECP being NR and in PR after steroid was 86% and 96%, respectively. After a median follow up of 20 months (range 2–72), 15/45 patients (33%) developed cGHVD and 16/45 patients (35%) died, in 3 cases for aGVHD. A trend for a better survival was seen among patients who started ECP in PR after steroid (80% vs 50% at 2 years; p=0,07). Overall, 22/49 (45%) and 17/49 (35%) patients with steroid refractory cGHVD achieved CR and PR after ECP, respectively. After a median follow up of 27 months, 44/49 patients (90%) are alive, 21 of whom (48%) on steroid. CONCLUSIONS: ECP is confirmed as an effective second-line treatment in both acute and chronic GVHD, as it can induce a response in more than 80% of the patients and a long term survival in at least 50% of the cases.