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An update of Italian best practice recommendations for ECP use in GvHD
By Ella Dixon
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The SIdEM and GITMO groups published the Italian “Best Practice Recommendations” in 2013 for the treatment of GvHD with ECP. Following the publication of additional studies on the use of ECP in GvHD, and updates to the EBMT consensus recommendation of management of GvHD, the groups have recently published an update to these best practice recommendations in Transfusion and Apheresis Science. The updated recommendations define the criteria for the use of ECP in patients with aGvHD and cGvHD by addressing the following areas:
A panel of experts in GvHD management and treatment with ECP was formed who discussed the key aspects of the recommendations. |
| Key learnings: |
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Historically, ECP has been recommended as a second-line treatment for GvHD. Data from over 1,000 patients across 18 reports show a median ORR of 66% with ECP treatment, with no safety concerns. Therefore, the recommendations maintain that ECP is used as a second-line treatment for patient with aGvHD refractory to first-line treatment. |
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Similarly, the recommendations suggest that ECP is used as a second-line treatment in patients with cGvHD refractory to first-line treatment, supported by data from over 700 patients, with a median ORR of 68%. |
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The recommendations state that in patients who are candidates for ECP, initial ECP scheduling should be one cycle per week for the first 4 weeks in aGvHD and one cycle every other week for the first 12 weeks in cGvHD. |
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ECP can be combined with other treatments; however, in the real-world, it should be performed with caution due to the risk of unexpected toxicities. It is recommended that, in the context of clinical trials, ECP could be investigated as a first-line therapy or as a GvHD prophylactic. |
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ECP should not be performed in the presence of cardio-circulatory and respiratory problems, severe infection, presence of aphakia, pregnancy, and sensitivity to psoralen compounds or the anticoagulant used. |
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Gradual tapering of immunosuppressives, including monitoring for GvHD reactivation, should only be considered in patients who achieve a GvHD response with ECP treatment. |
Abbreviations: aGvHD, acute graft-versus-host disease; cGvHD, chronic graft-versus-host disease; EBMT, European Society for Blood and Marrow Transplantation; ECP, extracorporeal photopheresis; GITMO, Italian Transplant Group for Bone Marrow Transplantation, Hematopoietic Stem Cells and Cell Therapy; ORR, overall response rate; SIDEM, Italian Society of Hemapheresis and Cell Manipulation.
- Colpo A, Marchetti M, Bianco I, et al. Treatment of acute and chronic graft-versus-host disease with extracorporeal photopheresis: Update of best practice recommendations from Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and the Italian Transplant Group for Bone Marrow Transplantation, Hematopoietic Stem Cells and Cell Therapy (GITMO). Transfus Apher Sci. 2024;63(5):103990. DOI: 10.1016/j.transci.2024.103990
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