Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease
Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease
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DOI：
10.1182/blood.v92.9.3098.421k32_3098_3104
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发表时间：
1998-11-01
期刊：
影响因子：
20.3
通讯作者：
Knobler, RM
中科院分区：
文献类型：
--
作者：
Greinix, HT;Volc-Platzer, B;Knobler, RM
外周血单个核细胞体外暴露于光敏化合物8-甲氧基卟啉和紫外线A辐射已被证明是有效的治疗几个T细胞介导的疾病，包括皮肤T细胞淋巴瘤和器官移植后的排斥反应。我们报告了21例恶性血液病患者（10例男性和11例女性），中位年龄为36岁（范围25 - 55岁），接受了来自同胞（n = 12）或无关（n = 9）供体的骨髓移植。6例患者发生急性移植物抗宿主病（GVHD）II级至III级，在接受体外光化学疗法（ECP）时对环孢素A（CSA）和泼尼松龙无反应。在15例患者中，骨髓移植（BMT）后2至24个月，广泛的慢性GVHD累及皮肤（0 = 15），肝脏（0 = 10），口腔粘膜（0 = 11），眼腺（0 = 6），和血小板减少症（0 = 3），并对常规治疗，包括类固醇无反应。所有患者在前3个月每2周连续2天接受ECP治疗，此后每4周接受一次，直至GVHD消退。ECP耐受性良好，无明显副作用。在平均14个周期的ECP治疗后，6例患者中有4例（67%）的急性GVHD完全消退，另有2例患者部分消退。15例患者中有12例（80%）皮肤慢性GVHD完全消退。硬皮病引起的膝关节和肘关节挛缩部分消退。所有患者的口腔粘膜溃疡均消退。10例肝脏受累患者中有7例（70%）在ECP后完全缓解。停止ECP后，未观察到严重感染。我们的研究结果表明，ECP是一种安全有效的辅助治疗急性和广泛的慢性GVHD与皮肤和内脏受累和抵抗常规治疗。(C)1998年，美国血液学会。
Extracorporeal exposure of peripheral blood mononuclear cells to the photosensitizing compound 8-methoxypsoralen and ultraviolet A radiation has been shown to be effective in the treatment of several T-cell-mediated diseases, including cutaneous T-cell lymphoma and rejection after organ transplantation. We present 21 patients (10 men and 11 women) with hematological malignancies with a median age of 36 years (range, 25 to 55 years) who had received marrow grafts from sibling (n = 12) or unrelated (n = 9) donors. Six patients had acute graft-versus-host disease (GVHD) grade II to III not responding to cyclosporine A (CSA) and prednisolone when referred to extracorporeal photochemotherapy (ECP). In 15 patients, 2 to 24 months after bone marrow transplantation (BMT), extensive chronic GVHD with involvement of skin (0 = 15), liver (0 = 10), oral mucosa (0 = 11), ocular glands (0 = 6), and thrombocytopenia (0 = 3) developed and was unresponsive to conventional therapy, including steroids. All patients were treated with ECP on 2 consecutive days every 2 weeks for the first 3 months and thereafter every 4 weeks until resolution of GVHD. ECP was tolerated excellently without any significant side effects. After a median of 14 cycles of ECP, acute GVHD resolved completely in 4 of 6 patients (67%) and partially in another 2 patients. Cutaneous chronic GVHD completely resolved in 12 of 15 (80%) patients. Contractures of knees and elbows due to scleroderma resolved partially. Oral mucosal ulcerations resolved in all patients. Seven of 10 patients (70%) with liver involvement had complete responses after ECP. After discontinuation of ECP, no severe infections were observed. Our findings suggest that ECP is a safe and effective adjunct therapy for both acute and extensive chronic GVHD with skin and visceral involvement and resistance to conventional therapy. (C) 1998 by The American Society of Hematology.