EXTRACORPOREAL PHOTOPHERESIS AS A TREATMENT FOR ACUTE AND CHRONIC GRAFT VERSUS HOST DISEASE. A SINGLE CENTER EXPERIENCE IN SPAIN.
(Abstract release date: 05/21/15)
EHA Library. Fonseca Cipagauta J. 06/12/15; 102662; PB2030
Disclosure(s): Hospital Ramón y CajalHaematology Department
Jaiver Alexander Fonseca Cipagauta
Contributions
Contributions
Abstract
Abstract: PB2030
Type: Publication Only
Background
Graft versus host disease (GvHD) is the most important cause of mortality and morbidity in patients who have undergone allogeneic stem cell transplantation. Currently, high-dose steroid is the first line of therapy in this disease. Nevertheless, there are no guidelines or agreement about the second and subsequent lines of treatment, so this still remains a matter of discussion. Extracorporeal photopheresis (ECP) has shown to be an effective and safe option to treat GvHD.
Aims
To evaluate the efficacy and safety of ECP in GvHD treatment in our center.
Methods
Since 2011 we have treated with ECP (Therakos System) a total of 25 patients with acute GvHD (aGvHD) (group 1) (n=12) and chronic GvHD (cGvHD) (group 2) (n=13) with refractory disease to two or more previous lines of therapy. Patients in group 1 were treated with weekly cycles and response was evaluated at week 6-8 after treatment was started. Patients in group 2 were treated every 2 weeks and response was evaluated at month 3-4. In group 1 Complete Response (CR) was defined as resolution of all symptoms, Partial Response (PR) as improvement of at least one grade compared to baseline and, Non Response (NR) when patients did not accomplish any of the other definitions. In group 2 CR was defined as symptom resolution with immunosuppressant treatment discontinuation, PR as improvement of more than 50% over baseline and/or reduction of more than 50% in immunosuppressant treatment, Minimum Response (MR) as improvement less than 50% over baseline and/or immunosuppressant reduction between 25-50% and Progression (PG) as clinical worsening or new organ involvement. The Modified Glucksberg classification was used to stage aGvHD and the NIH criteria to stage cGvHD.
Results
GvHD staging was 16%, 42% and 42% for grade II, III and IV respectively in group 1 and 8%, 38% and 54% for mild, moderate and severe in group 2. Group 1 was treated with a median of 6 cycles (1-12) and group 2 with a median of 9 cycles (3-22). The responses in group 1 was CR= 25%, PR= 33% and NR= 42% and in group 2 was CR= 15%, PR= 54%, MR= 8% and PG= 23%. The mortality rate was 67% for group 1 and 54% for group 2. The main causes of mortality were infections (88% and 57% for group 1 and 2) and GvHD progression (12% and 29% for group 1 and 2). The only complication associated to ECP was catheter infection (2 cases).
Summary
In our experience, ECP has proven to be a safe and effective treatment for patients with aGvHD and cGvHD. Prospective studies are required to establish indications and treatment guidelines.
Keyword(s): Allogeneic stem cell transplant, Bone marrow transplant, Extracorporeal photopheresis, Graft-versus-host disease (GVHD)
Session topic: Publication Only
Type: Publication Only
Background
Graft versus host disease (GvHD) is the most important cause of mortality and morbidity in patients who have undergone allogeneic stem cell transplantation. Currently, high-dose steroid is the first line of therapy in this disease. Nevertheless, there are no guidelines or agreement about the second and subsequent lines of treatment, so this still remains a matter of discussion. Extracorporeal photopheresis (ECP) has shown to be an effective and safe option to treat GvHD.
Aims
To evaluate the efficacy and safety of ECP in GvHD treatment in our center.
Methods
Since 2011 we have treated with ECP (Therakos System) a total of 25 patients with acute GvHD (aGvHD) (group 1) (n=12) and chronic GvHD (cGvHD) (group 2) (n=13) with refractory disease to two or more previous lines of therapy. Patients in group 1 were treated with weekly cycles and response was evaluated at week 6-8 after treatment was started. Patients in group 2 were treated every 2 weeks and response was evaluated at month 3-4. In group 1 Complete Response (CR) was defined as resolution of all symptoms, Partial Response (PR) as improvement of at least one grade compared to baseline and, Non Response (NR) when patients did not accomplish any of the other definitions. In group 2 CR was defined as symptom resolution with immunosuppressant treatment discontinuation, PR as improvement of more than 50% over baseline and/or reduction of more than 50% in immunosuppressant treatment, Minimum Response (MR) as improvement less than 50% over baseline and/or immunosuppressant reduction between 25-50% and Progression (PG) as clinical worsening or new organ involvement. The Modified Glucksberg classification was used to stage aGvHD and the NIH criteria to stage cGvHD.
Results
GvHD staging was 16%, 42% and 42% for grade II, III and IV respectively in group 1 and 8%, 38% and 54% for mild, moderate and severe in group 2. Group 1 was treated with a median of 6 cycles (1-12) and group 2 with a median of 9 cycles (3-22). The responses in group 1 was CR= 25%, PR= 33% and NR= 42% and in group 2 was CR= 15%, PR= 54%, MR= 8% and PG= 23%. The mortality rate was 67% for group 1 and 54% for group 2. The main causes of mortality were infections (88% and 57% for group 1 and 2) and GvHD progression (12% and 29% for group 1 and 2). The only complication associated to ECP was catheter infection (2 cases).
Summary
In our experience, ECP has proven to be a safe and effective treatment for patients with aGvHD and cGvHD. Prospective studies are required to establish indications and treatment guidelines.
Keyword(s): Allogeneic stem cell transplant, Bone marrow transplant, Extracorporeal photopheresis, Graft-versus-host disease (GVHD)
Session topic: Publication Only
Abstract: PB2030
Type: Publication Only
Background
Graft versus host disease (GvHD) is the most important cause of mortality and morbidity in patients who have undergone allogeneic stem cell transplantation. Currently, high-dose steroid is the first line of therapy in this disease. Nevertheless, there are no guidelines or agreement about the second and subsequent lines of treatment, so this still remains a matter of discussion. Extracorporeal photopheresis (ECP) has shown to be an effective and safe option to treat GvHD.
Aims
To evaluate the efficacy and safety of ECP in GvHD treatment in our center.
Methods
Since 2011 we have treated with ECP (Therakos System) a total of 25 patients with acute GvHD (aGvHD) (group 1) (n=12) and chronic GvHD (cGvHD) (group 2) (n=13) with refractory disease to two or more previous lines of therapy. Patients in group 1 were treated with weekly cycles and response was evaluated at week 6-8 after treatment was started. Patients in group 2 were treated every 2 weeks and response was evaluated at month 3-4. In group 1 Complete Response (CR) was defined as resolution of all symptoms, Partial Response (PR) as improvement of at least one grade compared to baseline and, Non Response (NR) when patients did not accomplish any of the other definitions. In group 2 CR was defined as symptom resolution with immunosuppressant treatment discontinuation, PR as improvement of more than 50% over baseline and/or reduction of more than 50% in immunosuppressant treatment, Minimum Response (MR) as improvement less than 50% over baseline and/or immunosuppressant reduction between 25-50% and Progression (PG) as clinical worsening or new organ involvement. The Modified Glucksberg classification was used to stage aGvHD and the NIH criteria to stage cGvHD.
Results
GvHD staging was 16%, 42% and 42% for grade II, III and IV respectively in group 1 and 8%, 38% and 54% for mild, moderate and severe in group 2. Group 1 was treated with a median of 6 cycles (1-12) and group 2 with a median of 9 cycles (3-22). The responses in group 1 was CR= 25%, PR= 33% and NR= 42% and in group 2 was CR= 15%, PR= 54%, MR= 8% and PG= 23%. The mortality rate was 67% for group 1 and 54% for group 2. The main causes of mortality were infections (88% and 57% for group 1 and 2) and GvHD progression (12% and 29% for group 1 and 2). The only complication associated to ECP was catheter infection (2 cases).
Summary
In our experience, ECP has proven to be a safe and effective treatment for patients with aGvHD and cGvHD. Prospective studies are required to establish indications and treatment guidelines.
Keyword(s): Allogeneic stem cell transplant, Bone marrow transplant, Extracorporeal photopheresis, Graft-versus-host disease (GVHD)
Session topic: Publication Only
Type: Publication Only
Background
Graft versus host disease (GvHD) is the most important cause of mortality and morbidity in patients who have undergone allogeneic stem cell transplantation. Currently, high-dose steroid is the first line of therapy in this disease. Nevertheless, there are no guidelines or agreement about the second and subsequent lines of treatment, so this still remains a matter of discussion. Extracorporeal photopheresis (ECP) has shown to be an effective and safe option to treat GvHD.
Aims
To evaluate the efficacy and safety of ECP in GvHD treatment in our center.
Methods
Since 2011 we have treated with ECP (Therakos System) a total of 25 patients with acute GvHD (aGvHD) (group 1) (n=12) and chronic GvHD (cGvHD) (group 2) (n=13) with refractory disease to two or more previous lines of therapy. Patients in group 1 were treated with weekly cycles and response was evaluated at week 6-8 after treatment was started. Patients in group 2 were treated every 2 weeks and response was evaluated at month 3-4. In group 1 Complete Response (CR) was defined as resolution of all symptoms, Partial Response (PR) as improvement of at least one grade compared to baseline and, Non Response (NR) when patients did not accomplish any of the other definitions. In group 2 CR was defined as symptom resolution with immunosuppressant treatment discontinuation, PR as improvement of more than 50% over baseline and/or reduction of more than 50% in immunosuppressant treatment, Minimum Response (MR) as improvement less than 50% over baseline and/or immunosuppressant reduction between 25-50% and Progression (PG) as clinical worsening or new organ involvement. The Modified Glucksberg classification was used to stage aGvHD and the NIH criteria to stage cGvHD.
Results
GvHD staging was 16%, 42% and 42% for grade II, III and IV respectively in group 1 and 8%, 38% and 54% for mild, moderate and severe in group 2. Group 1 was treated with a median of 6 cycles (1-12) and group 2 with a median of 9 cycles (3-22). The responses in group 1 was CR= 25%, PR= 33% and NR= 42% and in group 2 was CR= 15%, PR= 54%, MR= 8% and PG= 23%. The mortality rate was 67% for group 1 and 54% for group 2. The main causes of mortality were infections (88% and 57% for group 1 and 2) and GvHD progression (12% and 29% for group 1 and 2). The only complication associated to ECP was catheter infection (2 cases).
Summary
In our experience, ECP has proven to be a safe and effective treatment for patients with aGvHD and cGvHD. Prospective studies are required to establish indications and treatment guidelines.
Keyword(s): Allogeneic stem cell transplant, Bone marrow transplant, Extracorporeal photopheresis, Graft-versus-host disease (GVHD)
Session topic: Publication Only
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