ECP in adult patients with GvHD: A real-world experience

Extracorporeal photopheresis (ECP) can be used to treat adult patients with steroid-refractory or steroid-dependent graft-versus-host disease (GvHD).¹ The optimal schedule for ECP treatment is not defined clearly, and it is thought that using an off-line treatment schedule, rather than the traditional in-line regime, may allow for fewer sessions as well as a reduced amount of disposal apheresis instrumentation.¹

Here, we summarize key findings regarding real-world experience in ECP for adults with GvHD, published by Canto et al.¹ in Transplantation and Cellular Therapy.

Study design¹

• Patients were eligible for inclusion if they had been diagnosed with acute GvHD (aGvHD) or chronic GvHD (cGvHD) and had previously undergone at least one off-line ECP session.
  • ECP was indicated for these patients after the failure of steroid therapy.
• In total, 82 adult patients ≥18 years were included for analysis, and 1,382 ECP procedures were performed.
• Off-line ECP procedure:
  • 28 patients with aGvHD received: 2 procedures per week for 2 weeks, followed by 1 procedure per week for 2 weeks, and then 1 procedure biweekly for 5 months;
  • 54 patients with cGvHD received: 1 procedure per week for 1 month, followed by 1 procedure biweekly for 5 months;
  • ECP was tapered for each patient based on the individual’s GvHD response and introduction or withdrawal of immunosuppressants.
• Steroids were tapered by 0.2 mg/kg prednisone-equivalent per day, every day for 5 days in aGvHD, and 20–30% every 2 weeks in cGvHD.
• Cumulative incidences of response, including complete response (CR) and partial response (PR), were compared among patients grouped by different baseline, apheresis, and disease characteristics.

Key findings¹

In the aGvHD cohort, patients who responded to ECP treatment had a 1-year overall survival (OS) of 67.5%, whereas patients who did not respond had an OS of 26.0% (p = 0.037). Patients in the cGvHD cohort who responded to ECP treatment had a 1-year OS of 85.0%, and those who did not respond had an OS of 85.7% (p = 0.57). Table 1 summarizes the response rates and median duration of response of patients who received ECP treatment.

Table 1. Efficacy outcomes following ECP treatment*

Below, Figure 1 illustrates complete response rates in patients with aGvHD and cGvHD, focusing on skin, gut, and liver involvement.

Figure 1. Patients who achieved CR, in specific organs, after ECP treatment*

aGvHD, acute graft-versus-host disease; cGvHD, chronic graft-versus-host disease; CR, complete response; ECP, extracorporeal photopheresis.
*Adapted from Canto, et al.¹

Incidences that prevented ECP procedures included issues with venous access, autologous mononuclear cell collection, apheresis instrumentation errors, and psychological intolerances (1.4%); the remainder of the ECP procedures (98.6%) were completed successfully.