Extracorporeal photochemotherapy as second- or first-line therapy of acute GVHD?

摘要

Extracorporeal photochemotherapy (ECP) is a fascinating type of immunotherapy that is capable of providing immune tolerance without immunosuppression. A clinical benefit has first been suggested in patients with chronic GVHD, and several prospective or retrospective studies reported promising results in patients with steroid refractory acute GVHD (aGVHD). The theoretical advantages of ECP are no increased risk of infection, no adverse events such as metabolic or organic impairment and potential preservation of the GVL effect. Moreover, as its immuno-modulatory effects do not rely on the destruction or inactivation of cells but rather on the generation of active immune cells, these effects can be sustained and no severe flare-up of GVHD has been reported. In a recent retrospective study, Calore et al. have compared the outcome of children with aGVHD depending on whether they had been treated with ECP or not. In this study, the indications for ECP were steroid resistance or dependence, or viral reactivations. The authors reported a nonsignificant rise in the survival rate of children in the ECP group compared with children who did not meet the indications for ECP. In particular, in this group of 15 patients of whom 4 had grade IV aGVHD, none died from either aGVHD or chronic GVHD.