Extracorporeal photochemotherapy for treatmentof acute and chronic GVHD in childhood

Authors

  • Laura Salvaneschi,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Cesare Perotti,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Marco Zecca,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Stefano Bernuzzi,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Gianluca Viarengo,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Giovanna Giorgiani,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Claudia Del Fante,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Paola Bergamaschi,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Rita Maccario,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Andrea Pession,

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Franco Locatelli

    1. From the Immunohematology and Transfusion Service, Center for Transplant Immunology, and the Pediatric Hematology-Oncology Division, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy; and the Pediatric Department, San Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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  • Supported in part by grants from AIRC (Italian Association for Cancer Research), CNR (National Council for Research), MURST (University and Scientific Research Ministry), and IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Policlinico S. Matteo (FL).

Address reprint requests to: Laura Salvaneschi, MD, Servizio Trasfusionale e di Immunoematologia, IRCCS Policlinico San Matteo, P. le Golgi, 2, I-27100 Pavia, Italy; e-mail: c.perotti@smatteo.pv.it.

Abstract

BACKGROUND: Extracorporeal photochemotherapy (EPC) has recently been proposed for the treatment of adults with either acute or chronic GVHD. However, data on children given this therapy are scarce. A Phase I-II study was carried out on EPC in children experiencing GVHD after allogeneic transplantation of HPCs.

STUDY DESIGN AND METHODS: Nine patients with steroid-resistant, grade II-IV acute GVHD and 14 with chronic GVHD, all of whom had been refractory to at least one line of treatment, were enrolled in this study and analyzed. The median age was 10.3 years (range, 5.4-18.1), and the median body weight was 35 kg (range, 17-89).

RESULTS: Seven of the nine patients with acute GVHD showed a response to EPC, whereas the disease progressed in the remaining two children (both with skin, gastrointestinal, and liver GVHD), and they died of grade IV acute GVHD. Among the seven children who responded to EPC, it was possible to completely discontinue immunosuppressive treatment in three. In the 14 children with chronic GVHD, 4 and 5 patients experienced complete and partial response to EPC, respectively, whereas the remaining 5 patients, all with extensive chronic GVHD, had stable disease or disease that progressed during EPC. Among these latter 5 patients, 3 died. In 6 of the 9 patients with chronic GVHD responding to EPC, immunosuppressive therapy was discontinued.

CONCLUSION: EPC is safe, feasible, and effective in children with either acute or chronic GVHD occurring after an allograft.

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