Extracorporeal photopheresis for acute and chronic graft-versus-host disease: does it work?
Acute and chronic graft-versus-host disease (GVHD) continue to be major limitations to successful hematopoietic stem cell transplantation. A variety of different immunosuppressive and immunomodulating modalities have been tested in chronic GVHD, among them extracorporeal photopheresis. Photopheresis is currently indicated and Food and Drug Administration-approved for the treatment of skin manifestations of cutaneous T-cell lymphoma, where the response rate has proved to be considerably high. Extracorporeal photochemotherapy has been evaluated in small cohorts of patients with both acute and chronic GVHD. In steroid-refractory acute GVHD of the skin and liver, the reported response rate is more than 60%, especially in patients with less severe forms of the disease. There is more extensive experience in the treatment of chronic GVHD; overall response rates of 50% and higher have been reported in patients with skin, oral, eye, liver, gastrointestinal, or lung involvement. At our center, w
