BMT Tandem Meetings | Infliximab with or without extracorporeal photopheresis for steroid-refractory acute GvHD

Data from a single-center, retrospective analysis of patients with for steroid-refractory acute graft-versus-host disease (SR-aGvHD), led by Marietta Nygaard of Rigshospitalet Copenhagen University Hospital was presented Wednesday February 21 at the 2018 BMT Tandem Meetings in Salt Lake City, Utah. The study analyzed 17 years (2000 to 2017) of inflixmab patient outcomes compared with 5 years (2013 to 2017) of extracorporeal photopheresis (ECP) added to infliximab.

Key findings:

• N = 103 total patients
  • N = 67 infliximab only
  • N = 36 infliximab + ECP
• Baseline differences in treatment groups
  • More matched unrelated donors in ECP group, P = 0.008
  • More GI GvHD in infliximab group, P = 0.00
  • More skin GvHD in ECP group, P = 0.01
  • Lower dose of prednisone equivalent in ECP group, P = 0.001
• Freedom from treatment failure at 6 months
  • Infliximab = 35.8%
  • Infliximab + ECP = 44.4%
• Trend toward better 5-year overall survival in ECP group, P = 0.088

This small, single center analysis suggests improvement in outcomes for SR-aGvHD by using combination therapy of infliximab and ECP. Larger, prospective trials should be initiated to validate the clinical trends observed in this study.