ORIGINAL ARTICLES   

Giornale Italiano di Dermatologia e Venereologia 2002 February;137(1):15-24

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Graft versus chronic host disease and extracorporeal photochemotherapy

Rubegni P., Sbano P., De Aloe G., Guidi S., D’Ascenzo G., Rossi Ferrini P., Fimiani M.

Istituto di Scienze Dermatologiche Università degli Studi - Siena *U.O. di Ematologia - Servizio Trapianti Midollo Osseo Policlinico di Careggi - Firenze

Background. Chronic graft versus host disease (GvHD) affects 50% of long-term marrow transplant survivors and is lethal in 20 to 40% of affected patients despite aggressive therapy. Extracorporeal photochemotherapy (ECP), considered as an effective treatment for patients with erythrodermic cutaneous T-cell lymphoma, recently has been used in the treatment of GvHD. It consists on infusion of UVA irradiated autologous peripheral blood mononuclear cells collected by apheresis and incubated with 8-methoxypsoralen.
Methods. Personal experience in 9 patients with chronic GvHD following allogenic marrow transplantation for acute myeloid leukemia (n=4) or chronic myeloid leukemia (n=5) treated with ECP, is reported.
Results. In all treated patients, a partial or complete response of cutaneous, oral/ocular and liver involvement was observed after therapy. Moreover, in all cases it was possible to reduce or discontinue immunosuppressive therapy.
Conclusions. ECP is effective either as single or concomitant therapy in patients with chronic GvHD without relevant side effects. A randomized comparative multicenter study between ECP and conventional therapies is required to firmly establish photopheresis as the treatment of choice in chronic GvHD.