Effects of extracorporeal photopheresis on survival in chronic graft versus host disease

Yıl 2024, , 358 - 365, 30.10.2024

Ahmet Kaya , Mehmet Ali Erkurt , İrfan Kuku , Emin Kaya , İlhami Berber , Soykan Biçim , Süleyman Arslan , Ayse Uysal Fatma Hilal Yagın

https://doi.org/10.5472/marumj.1573775

Öz

ABSTRACT
Objective: Chronic graft versus host disease (cGVHD) develops after allogeneic hematopoietic cell transplantation, when immune
cells from a non-identical donor initiate an immune reaction against the transplant recipient. Extracorporeal photopheresis (ECP) can
be used in combination with prednisone in steroid-resistant cGVHD. In this study, the effect of ECP use on survival in cGVHD was
examined.
Patients and Methods: Twenty-six patients who were followed up in the adult Hematology Clinic of Inonu University Turgut Ozal
Medical Center for cGVHD were included in the study. Stem cell transplantation and ECP application parameters that may affect the
survival of the patients were examined.
Results: The degree of involvement in cGVHD affects survival. Involvements with clinical and laboratory scores of 2 and above
according to the National Institutes of Health consensus criteria, significantly reduced survival. The development time of cGVHD
was found to be associated with survival, and that it had a positive impact on survival, especially when the disease developed after 220
days after the transplantation. It was observed that steroid dose taken during ECP, patient age and cGVHD prophylaxis used affected
survival.
Conclusion: The use of ECP may be effective in survival, especially, in patients who develop cGVHD, 220 days after allogeneic
transplantation. Concurrent use of steroids with ECP affects survival.

Anahtar Kelimeler

Graft versus host disease, Allogeneic hematopoietic cell transplantation, Extracorporeal photopheresis, Survival

Kaynakça

• Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease. The 2014 diagnosis and staging working group report. Biol Blood Marrow Transplant 2015; 21:389-401. doi: 10.1016/j.bbmt.2014.12.001
• Filipovich AH, Weisdorf D, Pavletic S, et al. National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11:945-56. doi: 10.1016/j.bbmt.2005.09.004
• Lee SJ, Vogelsang G, Flowers ME. Chronic graft-versus-host disease. Biol Blood Marrow Transplant 2003; 9:215-33. doi: 10.1053/bbmt.2003.50026
• Ozawa S, Nakaseko C, Nishimura M, et al. Chronic graft-versus-host disease after allogeneic bone marrow transplantation from an unrelated donor: incidence, risk factors and association with relapse. A report from the Japan marrow donor program. Br J Haematol 2007; 137:42-51. doi: 10.1111/j.1365-2141.2007.06543.x
• Flowers ME, Inamoto Y, Carpenter PA, et al. Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to national institutes of health consensus criteria. Blood 2011; 117:3214- 9. doi: 10.1182/blood-2010-08-302109.
• Jamalis J, Yusof FSM, Chander S, et al. Psoralen derivatives: Recent advances of synthetic strategy and pharmacological properties.Antiinflamm Antiallergy Agents Med Chem 2020;19:222-39. doi: 10.2174/187.152.3018666.190.625170802
• Thomaz DV, de Oliveira MG, Rodrigues ESB, da Silva VB, Dos Santos PA. Physicochemical investigation of psoralen binding to double stranded DNA through electroanalytical and cheminformatic approaches. Pharmaceuticals (Basel) 13 2020;13:108. doi: 10.3390/ph13060108.
• Van Aelst B, Devloo R, Zachée P, et al. Psoralen and ultraviolet a light treatment directly affects phosphatidylinositol 3-kinase signal transduction by altering plasma membrane packing. J Biol Chem 2016;291:24364-76. doi: 10.1074/jbc.M116.735126
• Dignan FL, Aguilar S, Scarisbrick JJ, et al. Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD. Bone Marrow Transplant 2014; 49:704-8. doi: 10.1038/bmt.2014.21
• Das-Gupta E, Dignan F, Shaw B, et al. Extracorporeal photopheresis for treatment of adults and children with acute GVHD: UK consensus statement and review of published literature. Bone Marrow Transplant 2014; 49:1251-8. doi: 10.1038/bmt.2014.106
• Axt L, Naumann A, Toennies J, et al. Retrospective single center analysis of outcome, risk factors and therapy in steroid refractory graft-versus-host disease after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2019; 54:1805-14. doi: 10.1038/s41409.019.0544-y
• Siripornkitti W, Pengpis N, Chanswangphuwana C, Prueksrisakul T. Therapeutic response of oral chronic graftversus- host disease to topical corticosteroids according to the 2014 National Institute of Health (USA) consensus criteria. Med Oral Patol Oral Cir Bucal 2024 ;29:e219-e226. doi: 10.4317/medoral.26203
• Drexler B, Buser A, Infanti L, Stehle G, Halter J, Holbro A. Extracorporeal photopheresis in graft-versus-host disease. Transfus Med Hemother 2020;47:214-25. doi: 10.1159/000508169
• Kaynar L, Tekgunduz E, Kozanoglu I, et al. Extracorporeal photopheresis in the treatment for acute and chronic graft-versus-host disease: A position statement from the Turkish society of apheresis (TSA). Transfus Apher Sci 2022;61 :103373. doi: 10.1016/j.transci.2022.103373
• Sakellari I, Gavriilaki E, Batsis I, et al. Favorable impact of extracorporeal photopheresis in acute and chronic graft versus host disease. J Clin Apher 2018;33:654-60. doi: 10.1002/ jca.21660
• Connelly-Smith L, Alquist CR, Aqui NA, et al. Guidelines on the use of therapeutic apheresis in clinical practice – evidencebased approach from the Writing Committee of the American Society for Apheresis. J Clin Apher 2023;38:77-278. doi: 10.1002/jca.22043
• Dal MS, Batgi H, Erkurt MA, et al. Extracorporeal photopheresis in steroid-refractory chronic graft-versus-host disease: A retrospective multicenter study. Transfus Apher Sci 2021;60:103243. doi: 10.1016/j.transci.2021.103243
• Cantó PA, Caballer JS, Alcaína PS, de la Rubia Comos J, Seguí IG. Extracorporeal photopheresis in graft-versus-host disease. Transplant Cell Ther 2023;29:556-66. doi: 10.1016/j. jtct.2023.07.001.