How I treat GvHD in children using ECP: Insights from a case study

During the GvHD Hub Steering Committee Meeting in July 2026, key opinion leaders met to discuss the use of extracorporeal photopheresis (ECP) for the treatment of pediatric graft-versus-host disease (GvHD). The meeting opened with a presentation from Andrew Harris, and featured a panel discussion with Mohamad Mohty, Corey Cutler, Hildegard Greinix, and Daniel Wolff.

During his presentation, Harris explained that, beyond first-line steroid therapy, the management of GvHD relies on a range of second-line treatment options, noting there are limited data and guidance specific to pediatric patients. Among these, ECP – an immunomodulatory leukapheresis-based therapy – is increasingly being incorporated into clinical practice as a second-line or later treatment. However, its use in pediatric patients remains variable, with no standardized approach. Harris presented a case from his practice involving a 3-year-old patient who developed acute GvHD following transplantation and was treated with ECP (Figure 1 and Figure 2). He also discussed the practical and logistical considerations associated with ECP and explored how micro-ECP may overcome some of the challenges limiting ECP use in pediatric patients.

Key points

• Beyond first-line corticosteroids, GvHD care depends on a range of second‑line options, with limited data and guidance specific to pediatric populations.^1–3
• There is a significant need for GvHD therapies that reduce reliance on steroids and broad immunosuppression in children.¹
• ECP, a leukapheresis-based procedure, is an established treatment option for acute and chronic GvHD.^2,4
• ECP has an immunomodulatory mechanism of action, rather than immunosuppressive, and is associated with steroid-sparing efficacy, minimal side effects, no infectious risk outside of central venous line, and no increased risk of relapse.^5–9
• Although ECP is increasingly incorporated in clinical practice and recognized in guidelines as a second-line or later treatment option, its use in pediatric patients remains heterogeneous, and the optimal treatment schedule is yet to be determined.^2,4 
• Harris presents a clinical case of a 3-year-old male who developed acute GvHD following bone marrow transplantation and was treated with ECP as second-line therapy following first-line corticosteroids.
  • The patient responded well to ECP, enabling successful corticosteroid tapering, and achieved a complete response by Day 80. After 8 weeks of twice-weekly ECP (Day 108), ECP treatment frequency was reduced without any recurrence of acute GvHD.
• The use of ECP in pediatric patients requires consideration of several practical and logistical factors, including the requirement for an apheresis-capable catheter, the use of blood priming in patients with a low body weight (<25 kg), the time commitment associated with treatment, and the need for administration in experienced centers with appropriate expertise.^4,8,10,11
• Although the method remains experimental, micro-ECP has demonstrated efficacy in the treatment of acute and chronic pediatric GvHD,
  • In a retrospective study (N = 23), micro-ECP was associated with overall response rates of 44% and 73% in pediatric patients with acute and chronic GvHD, respectively.¹²  
• Combination strategies involving ECP are increasingly being explored, with studies evaluating its use in combination with agents such as ruxolitinib and belumosudil.^13,14

This educational activity is independently supported by Therakos. All content is developed by the steering committee in collaboration with SES. Funders are allowed no influence.