Table 5.
Studies regarding use of ECP in cGvHD
| Study reference | Patients (n) | Study type | Treatment schedule | cGvHD | ORR | CR% | PR | Prior to ECP | During ECP | Catheter‐related | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Skin | Mucosa | Liver | GI | Ocular | Lung | |||||||||||
| Ussowicz et al (2013) | 13 | 4‐year OS 67·7% | ||||||||||||||
| Bykova et al (2013) | 49 | Retrospective | 74% | 76% | 82% | OS 70% | ||||||||||
| Hautmann et al (2013) | 32 | Retrospective, COBE Spectra | One cycle/week until improvement followed by one cycle every other week for 3–4 weeks and subsequent treatment one cycle every month | 59% | 60% | 100% | 44% | 2 (6%) | 12 (38%) | TRM deaths 11 (34%); Relapse deaths 3 (9%) | Steroids <50% in 29% patients after 3 months. 16% discontinued steroids |
Catheter infection: 3 AF: 1 |
||||
| Del Fante et al (2012) | 102 | 64 (62·7%) had classic cGvHD,24 (23·5%) had overlap cGvHD | 3 rounds of 2/week, 3 of 2 every other week, and finally 2/month until clinical improvement and/or IST tapering | 80% | 16 (15·7%) | 38 (37·3%) | Complete withdrawal of ECP in 56·25% | |||||||||
| Dignan et al (2012c) | 82 | Retrospective | Bimonthly for two consecutive days tapered to a monthly regimen depending on response | 91% | 91% | 65/69 (94%) had ≥50% improvement in symptoms and signs of cGvHD | 69% at 3 years | None (12), one (10), two (40),three (14), ≥four (6) | 80% had decreased their steroid dose (27·5% stopped, 30% had ≥75% reduction, 17·5% had ≥50% reduction and 25% had <50% reduction) | Skin with CR 7/62 (11%), PR 50/62 (81%); mucosa with CR 1/32 (3%), PR 28/32 (88%) | ||||||
| Greinix et al (2011) | 29 | Open‐label crossover ECP study | 3 times during week 1, then twice weekly until week 12, followed by 2 treatments monthly until week 24 | 31% | 70% | 50% | 60% | 57% | 31% | <25% reduction in corticosteroid dose at week 12 of the initial study | 4 (17%) and 8 (33%) patients, a >50% reduction in corticosteroid dose at weeks 12 and 24 was observed | |||||
| Flowers et al (2008) | 48 | Prospective phase 2 randomized study | 40% | 53% | 29% | 30% | At week 12, the proportion of patients who had at least a 50% reduction in steroid dose and at least a 25% decrease in TSS was 8% in the ECP arm vs. 0% in the control arm (P = 0·04) | |||||||||
| Jagasia et al (2009) | Overlap 12; cGvHD 31 | Classic and overlap | Paired weekly for 3–4 weeks and then decreased to an every 2‐ to 3‐week interval | 88% |
3 (10%) 10 (32%) 1 (3%) |
17 (55%) | 36% at 3 years | |||||||||
| Perseghin et al (2007) | 25 | 19 treatments | 80% | NK | NK | |||||||||||
| Gasova et al (2007) | 6 | 87% | ||||||||||||||
| Motolese et al (2007) | Prospective, ocular | 12 months ECP | 10/21 (48%) | |||||||||||||
| Bisaccia et al (2006) | 14 | ‘3 treatments over 17 months’ | 100% | 42% | 60% | 42% | 20% | 100% | 5‐year post‐transplantation survival: 77% | 4/13(31%) discontinued steroids | ||||||
| Couriel et al (2006) | 71 | 57% | 78% | 71% | 67% | 54% | 61% | 20% (14/71) | 53% at 1 year | Overall response 61%. Best responses were observed in skin, liver, oral mucosa and eye | ||||||
| Rubegni et al (2005) | 32 | 100% | 90% | 100% | 60% | 78% | ||||||||||
| Garban et al (2005) | 15 | 6 courses over 3 weeks followed by consolidation | 100% | 33% | 77% | 87% | 11/15 (73%) | 2/11 (18%) | ||||||||
| Foss et al (2005) | 25 | Prospective | 2 consecutive days every 2 weeks or one per week | 80% | 24% | 46% | 64% | ORR 64% | ||||||||
| Ilhan et al (2004) | 8 | 2 consecutive days every 2–4 weeks | 75% | 75% | ||||||||||||
| Seaton et al (2003) | 28 | Fortnightly for 4 months and then monthly | 53% | 50% | ||||||||||||
| Messina et al (2003) | 44 | 84% | 60% | 47% | 44% | 73% | 5‐year overall survival was 96% for responders versus 58% for non‐responders (P = 0·04). | |||||||||
| Bisaccia et al (2003) | 6 | Thrice weekly for mean 7·2 months | 100% | 100% | 81% | |||||||||||
| Apisarnthanarax et al (2003) | 32 | A median of 6 sessions per month | 56% | 56% | All 21 surviving patients remain on some therapy | |||||||||||
| Child et al (1999) | 11 | 2 treatments/2 weeks for 4 months then taper | 90% | 75% | 20% | 40% | PSE (9), CSA (7), Az (6), Th (3), PUVA (3) | PSE (7), CSA (5), Az (4) | ||||||||
| Greinix et al (1998) | 15 | 2 treatments/2 weeks for 3 months then 2 treatments/4 weeks | 80% | 100% | 70% | MP (13), CSA (11), Az (1), Th (2), PUVA (2) | MP (8), CSA (8), Th (1), none (2) | |||||||||
| Smith et al (1998) | 18 | 2–3 treatments/3 weeks | 36% | 30% | 0% | 33% | PSE (18), CSA (18), Th (8), PUVA (5) | PSE + CSA (all) | ||||||||
| Besnier et al (1997) | 5 | 3 treatments/week for 3 weeks then taper | 100% | 100% | 100% | PSE (2), MP (1), Th (1), none (2), CSA (1), Az (1) | PSE/MP (3), CSA (1), Az (1), Th (1) | |||||||||
| Rossetti et al (1996) | 8 | 2 treatments/3 weeks for 6 months then taper | 43% | 20% | 33% | 0% | 40% | PSE (5), CSA (5), Az (3), Th (3), MTX (2), Ab (1), NK (2) | PSE (3), CSA (3), NK (4) | |||||||
| Aubin et al (1995) | 7 | NK | 70% | NK | NK | |||||||||||
Ab, OKT3 monoclonal antibody; AF, atrial fibrillation; Az, azathioprine; cGvHD, chronic graft‐versus‐host disease; CR, complete response; CSA, ciclosporin; ECP, extracorporeal photopheresis; GI, gastrointestinal; IST, immunosuppressive therapy; MP, methylprednisolone; MTX, methotrexate; NK, not known; OR, overall response; PR, partial response; PSE, prednisolone; PUVA, psoralen–ultraviolet A, Th, thalidomide; TRM, treatment‐related mortality; TSS, total skin score.