Key considerations for the use of ECP in GvHD

On November 29, 2022, the GvHD Hub held a virtual symposium on the role of extracorporeal photopheresis (ECP) in the management of graft-versus-host disease (GvHD).

Here, we share the presentation given by Mohamad Mohty, Hôpital Saint-Antoine and Sorbonne Université, Paris, FR, which explored the key considerations for the use of ECP in GvHD.

In this presentation, Mohty discusses what is the most appropriate treatment approach in specific cases of acute GvHD (aGvHD) and chronic GvHD (cGvHD) post-allogenic stem cell transplant (allo‑HSCT). Using example cases paired with clinical data, this presentation evaluated the use of ECP plus steroids by assessing the safety and response rates as a first-line treatment option for aGvHD. Mohty then outlines indications for second-line therapy of cGvHD by discussing progression, disease stability, and the intolerance of first-line treatment of ECP plus steroids. Finally, the floor is opened to allow the panel to discuss supportive care options in cGvHD, in which they cover the themes summarized in Figure 1.

Figure 1. Areas of supportive care needed in chronic GvHD* 

GvHD, graft-versus-host-disease; Ig, immunoglobulin; IV, intravenous; VZV, varicella zoster virus.
*Mohamad Mohty. Personal communication; Nov 29, 2022.  

Watch the presentation to learn more about the key considerations for the use of ECP in GvHD, including:

• The allogenic stem cell transplant process (00:25; slide 5)
• Incidences of aGvHD and cGvHD over time (01:47; slide 6)
• The first-line treatment of aGvHD (02:21; slide 7)
• What ECP is (02:33, slide 8) and the mechanism of action (03:01; slide 9)
• A brief history of ECP (03:08; slide 10)
• Two example cases
  • ECP + steroid as first-line treatment of skin predominant aGvHD (3:31; slides 11–22)
  • ECP + steroids for the treatment of refractory cGvHD (18:47; slides 23–29)
• Supportive care in cGvHD (28:50; slides 31–32)

Key points

• aGvHD and cGvHD remain serious complications of allo-HSCT.
• The use of ECP has a potent immunomodulatory effect in patients.
• Promising efficacy results are seen with first-line treatment of ECP + steroids.
• Randomized clinical trials are still required to establish the value of ECP in patients.
• It is essential that patients with cGvHD receive supportive care, including infection prophylaxis.
• Further research into the development of predictive biomarkers for ECP may be helpful.