Extracorporeal photopheresis versus anticytokine therapy as a second-line treatment for steroid-refractory acute GVHD: a multicenter comparative analysis.

Jagasia M, Greinix H, Robin M, Das-Gupta E, Jacobs R, Savani BN, Engelhardt BG, Kassim A, Worel N, Knobler R, Russell N, Socie G
Biol Blood Marrow Transplant. 2013 19 (7): 1129-33

PMID: 23623892 · DOI:10.1016/j.bbmt.2013.04.018

The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P < .001) were independent predictors of response. ECP therapy, adjusted for conditioning regimen intensity and steroid dose, was associated with superior survival (hazard ratio [HR], 4.6; P = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P < .001) and lack of response to therapy (HR, 3.09; P = .011) were associated with inferior survival. These findings require validation in a prospective randomized study.

Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

MeSH Terms (23)

Acute Disease Adolescent Adrenal Cortex Hormones Adult Aged Antineoplastic Agents Child Child, Preschool Cytokines Drug Administration Schedule Female Graft vs Host Disease Hematopoietic Stem Cell Transplantation Humans Male Middle Aged Photopheresis Prognosis Retrospective Studies Survival Analysis Transplantation, Homologous Transplantation Conditioning Treatment Outcome

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