EXTRACORPOREAL PHOTOPHERESIS FOR THE TREATEMENT OF ACUTE AND CHRONIC GRAFT VERSUS HOST DISEASE: A RETROSPECTIVE MULTICENTRIC ANALYSIS ON 94 PATIENTS.
(Abstract release date: 05/19/16)
EHA Library. Malagola M. 06/09/16; 133090; E1541
Dr. Michele Malagola
Contributions
Contributions
Abstract
Abstract: E1541
Type: Eposter Presentation
Background
Extracorporeal photopheresis (ECP) is considered a valid second-line treatment of both acute and chronic GVHD, which represent the most frequent causes of morbidity and mortality after allo-SCT in hematological malignancies.
Aims
According to an observational multicentric study, we report here a retrospective analysis on the use and results of ECP in 94 patients with acute and chronic GVHD, recruited in 6 italian Centres.
Methods
94 patients with aGVHD grado 2 (n=45) and cGVHD (n=49) were submitted to ECP after first-line steroid-based therapy. ECP treatment consisted on conventional bi-weekly procedure for 4 weeks. Then, most of the patients were treated with bi-weekly procedures every 2 weeks for 4 other weeks. Response to steroid was assessed after 7 days for aGVHD and 15 days for cGVHD.
Results
aGHVD: 45 patients with aGVHD were treated with ECP. In 22 (49%) ECP was used as salvage treatment, being these patients non responsive to steroid (NR). 19/22 (86%) achieved a CR after ECP, whose median duration was 77 days (range 20-1112). The median duration of steroid therapy was 101 days (range 24-772), with a median of 22 days (range 7-80) on full steroid dose. The median duration of steroid on tapering was 82 days (range 0-756). 8/22 (36%) patients developed a cGVHD (extensive in 6 cases and limited in 2 cases). After a median follow up of 419 days (range 61-2149), 11/22 (50%) patients are alive. In 23/45 cases (51%) ECP was used earlier, being these patients partially responsive to steroid. Among these patients, 22 (96%) achieved the CR after ECP. In this setting of patients, the median duration of steroid was 88 days (range 32-719), with a median of 18 days (range 4-69) on full dose steroid therapy. The median duration of steroid on tapering was 68 days (range 0-700). The median duration of ECP treatment was 194 days (range 22-933). 7/23 (30%) patients developed a cGHVD (extensive in 6 cases and limited in 1 case). With a median follow up of 741 days (range 81-1819), 17/22 (77%) patients are alive. Among the 45 patients with aGVHD, the projected 2 years OS was 50% for the patients with steroid-refractory aGVHD versus 80% for the patients with steroid partially responsive aGVHD (p=0,07), and the cumulative incidence of cGVHD at 1 year was 48% vs 23%, respectively (p=0,32).cGVHD: 49 patients with cGVHD were treated wiht ECP. 12/49 (24%) and 37/49 (76%) had limited and extensive cGVHD, respectively. The median time of cGVHD onset was 193 days (range 43-3756), the median time from steroid to ECP was 26 days (range 0-1347) and the median duration of ECP was 276 days (range 19-2861). The median duration of steroid therapy in this group was 276 days (range 19-2861). 22/49 patients (45%) and 17/49 patients (35%) achieved a CR and PR, respectively. After a median follow up of 811 days (range 152-4676), 44/49 patients (90%) are alive, 28 of whom (64%) on immunosuppressive therapy.
Conclusion
ECP confirmed to be an effective treatment in aGVHD steroid-resistant patients as it can induce a CR in more than 80% of the cases, with 50% of these patients becoming long-term survivors. In aGVHD steroid partially-responsive patients it can probably allow a faster steroid tapering, with more than 70% of patients becoming long term survivors. In cGVHD steroid-resistant patients, ECP are associated with an overall response rate of 80%, with 90% of patients who become long-term survivors.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Graft-versus-host disease (GVHD), Photopheresis
Type: Eposter Presentation
Background
Extracorporeal photopheresis (ECP) is considered a valid second-line treatment of both acute and chronic GVHD, which represent the most frequent causes of morbidity and mortality after allo-SCT in hematological malignancies.
Aims
According to an observational multicentric study, we report here a retrospective analysis on the use and results of ECP in 94 patients with acute and chronic GVHD, recruited in 6 italian Centres.
Methods
94 patients with aGVHD grado 2 (n=45) and cGVHD (n=49) were submitted to ECP after first-line steroid-based therapy. ECP treatment consisted on conventional bi-weekly procedure for 4 weeks. Then, most of the patients were treated with bi-weekly procedures every 2 weeks for 4 other weeks. Response to steroid was assessed after 7 days for aGVHD and 15 days for cGVHD.
Results
aGHVD: 45 patients with aGVHD were treated with ECP. In 22 (49%) ECP was used as salvage treatment, being these patients non responsive to steroid (NR). 19/22 (86%) achieved a CR after ECP, whose median duration was 77 days (range 20-1112). The median duration of steroid therapy was 101 days (range 24-772), with a median of 22 days (range 7-80) on full steroid dose. The median duration of steroid on tapering was 82 days (range 0-756). 8/22 (36%) patients developed a cGVHD (extensive in 6 cases and limited in 2 cases). After a median follow up of 419 days (range 61-2149), 11/22 (50%) patients are alive. In 23/45 cases (51%) ECP was used earlier, being these patients partially responsive to steroid. Among these patients, 22 (96%) achieved the CR after ECP. In this setting of patients, the median duration of steroid was 88 days (range 32-719), with a median of 18 days (range 4-69) on full dose steroid therapy. The median duration of steroid on tapering was 68 days (range 0-700). The median duration of ECP treatment was 194 days (range 22-933). 7/23 (30%) patients developed a cGHVD (extensive in 6 cases and limited in 1 case). With a median follow up of 741 days (range 81-1819), 17/22 (77%) patients are alive. Among the 45 patients with aGVHD, the projected 2 years OS was 50% for the patients with steroid-refractory aGVHD versus 80% for the patients with steroid partially responsive aGVHD (p=0,07), and the cumulative incidence of cGVHD at 1 year was 48% vs 23%, respectively (p=0,32).cGVHD: 49 patients with cGVHD were treated wiht ECP. 12/49 (24%) and 37/49 (76%) had limited and extensive cGVHD, respectively. The median time of cGVHD onset was 193 days (range 43-3756), the median time from steroid to ECP was 26 days (range 0-1347) and the median duration of ECP was 276 days (range 19-2861). The median duration of steroid therapy in this group was 276 days (range 19-2861). 22/49 patients (45%) and 17/49 patients (35%) achieved a CR and PR, respectively. After a median follow up of 811 days (range 152-4676), 44/49 patients (90%) are alive, 28 of whom (64%) on immunosuppressive therapy.
Conclusion
ECP confirmed to be an effective treatment in aGVHD steroid-resistant patients as it can induce a CR in more than 80% of the cases, with 50% of these patients becoming long-term survivors. In aGVHD steroid partially-responsive patients it can probably allow a faster steroid tapering, with more than 70% of patients becoming long term survivors. In cGVHD steroid-resistant patients, ECP are associated with an overall response rate of 80%, with 90% of patients who become long-term survivors.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Graft-versus-host disease (GVHD), Photopheresis
Abstract: E1541
Type: Eposter Presentation
Background
Extracorporeal photopheresis (ECP) is considered a valid second-line treatment of both acute and chronic GVHD, which represent the most frequent causes of morbidity and mortality after allo-SCT in hematological malignancies.
Aims
According to an observational multicentric study, we report here a retrospective analysis on the use and results of ECP in 94 patients with acute and chronic GVHD, recruited in 6 italian Centres.
Methods
94 patients with aGVHD grado 2 (n=45) and cGVHD (n=49) were submitted to ECP after first-line steroid-based therapy. ECP treatment consisted on conventional bi-weekly procedure for 4 weeks. Then, most of the patients were treated with bi-weekly procedures every 2 weeks for 4 other weeks. Response to steroid was assessed after 7 days for aGVHD and 15 days for cGVHD.
Results
aGHVD: 45 patients with aGVHD were treated with ECP. In 22 (49%) ECP was used as salvage treatment, being these patients non responsive to steroid (NR). 19/22 (86%) achieved a CR after ECP, whose median duration was 77 days (range 20-1112). The median duration of steroid therapy was 101 days (range 24-772), with a median of 22 days (range 7-80) on full steroid dose. The median duration of steroid on tapering was 82 days (range 0-756). 8/22 (36%) patients developed a cGVHD (extensive in 6 cases and limited in 2 cases). After a median follow up of 419 days (range 61-2149), 11/22 (50%) patients are alive. In 23/45 cases (51%) ECP was used earlier, being these patients partially responsive to steroid. Among these patients, 22 (96%) achieved the CR after ECP. In this setting of patients, the median duration of steroid was 88 days (range 32-719), with a median of 18 days (range 4-69) on full dose steroid therapy. The median duration of steroid on tapering was 68 days (range 0-700). The median duration of ECP treatment was 194 days (range 22-933). 7/23 (30%) patients developed a cGHVD (extensive in 6 cases and limited in 1 case). With a median follow up of 741 days (range 81-1819), 17/22 (77%) patients are alive. Among the 45 patients with aGVHD, the projected 2 years OS was 50% for the patients with steroid-refractory aGVHD versus 80% for the patients with steroid partially responsive aGVHD (p=0,07), and the cumulative incidence of cGVHD at 1 year was 48% vs 23%, respectively (p=0,32).cGVHD: 49 patients with cGVHD were treated wiht ECP. 12/49 (24%) and 37/49 (76%) had limited and extensive cGVHD, respectively. The median time of cGVHD onset was 193 days (range 43-3756), the median time from steroid to ECP was 26 days (range 0-1347) and the median duration of ECP was 276 days (range 19-2861). The median duration of steroid therapy in this group was 276 days (range 19-2861). 22/49 patients (45%) and 17/49 patients (35%) achieved a CR and PR, respectively. After a median follow up of 811 days (range 152-4676), 44/49 patients (90%) are alive, 28 of whom (64%) on immunosuppressive therapy.
Conclusion
ECP confirmed to be an effective treatment in aGVHD steroid-resistant patients as it can induce a CR in more than 80% of the cases, with 50% of these patients becoming long-term survivors. In aGVHD steroid partially-responsive patients it can probably allow a faster steroid tapering, with more than 70% of patients becoming long term survivors. In cGVHD steroid-resistant patients, ECP are associated with an overall response rate of 80%, with 90% of patients who become long-term survivors.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Graft-versus-host disease (GVHD), Photopheresis
Type: Eposter Presentation
Background
Extracorporeal photopheresis (ECP) is considered a valid second-line treatment of both acute and chronic GVHD, which represent the most frequent causes of morbidity and mortality after allo-SCT in hematological malignancies.
Aims
According to an observational multicentric study, we report here a retrospective analysis on the use and results of ECP in 94 patients with acute and chronic GVHD, recruited in 6 italian Centres.
Methods
94 patients with aGVHD grado 2 (n=45) and cGVHD (n=49) were submitted to ECP after first-line steroid-based therapy. ECP treatment consisted on conventional bi-weekly procedure for 4 weeks. Then, most of the patients were treated with bi-weekly procedures every 2 weeks for 4 other weeks. Response to steroid was assessed after 7 days for aGVHD and 15 days for cGVHD.
Results
aGHVD: 45 patients with aGVHD were treated with ECP. In 22 (49%) ECP was used as salvage treatment, being these patients non responsive to steroid (NR). 19/22 (86%) achieved a CR after ECP, whose median duration was 77 days (range 20-1112). The median duration of steroid therapy was 101 days (range 24-772), with a median of 22 days (range 7-80) on full steroid dose. The median duration of steroid on tapering was 82 days (range 0-756). 8/22 (36%) patients developed a cGVHD (extensive in 6 cases and limited in 2 cases). After a median follow up of 419 days (range 61-2149), 11/22 (50%) patients are alive. In 23/45 cases (51%) ECP was used earlier, being these patients partially responsive to steroid. Among these patients, 22 (96%) achieved the CR after ECP. In this setting of patients, the median duration of steroid was 88 days (range 32-719), with a median of 18 days (range 4-69) on full dose steroid therapy. The median duration of steroid on tapering was 68 days (range 0-700). The median duration of ECP treatment was 194 days (range 22-933). 7/23 (30%) patients developed a cGHVD (extensive in 6 cases and limited in 1 case). With a median follow up of 741 days (range 81-1819), 17/22 (77%) patients are alive. Among the 45 patients with aGVHD, the projected 2 years OS was 50% for the patients with steroid-refractory aGVHD versus 80% for the patients with steroid partially responsive aGVHD (p=0,07), and the cumulative incidence of cGVHD at 1 year was 48% vs 23%, respectively (p=0,32).cGVHD: 49 patients with cGVHD were treated wiht ECP. 12/49 (24%) and 37/49 (76%) had limited and extensive cGVHD, respectively. The median time of cGVHD onset was 193 days (range 43-3756), the median time from steroid to ECP was 26 days (range 0-1347) and the median duration of ECP was 276 days (range 19-2861). The median duration of steroid therapy in this group was 276 days (range 19-2861). 22/49 patients (45%) and 17/49 patients (35%) achieved a CR and PR, respectively. After a median follow up of 811 days (range 152-4676), 44/49 patients (90%) are alive, 28 of whom (64%) on immunosuppressive therapy.
Conclusion
ECP confirmed to be an effective treatment in aGVHD steroid-resistant patients as it can induce a CR in more than 80% of the cases, with 50% of these patients becoming long-term survivors. In aGVHD steroid partially-responsive patients it can probably allow a faster steroid tapering, with more than 70% of patients becoming long term survivors. In cGVHD steroid-resistant patients, ECP are associated with an overall response rate of 80%, with 90% of patients who become long-term survivors.
Session topic: E-poster
Keyword(s): Allogeneic bone marrow transplant, Graft-versus-host disease (GVHD), Photopheresis
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