Symposium | Physician’s perspective: How I treat GvHD with ECP

During the 52nd Annual Meeting of the EBMT, the GvHD Hub held a live symposium on March 24, 2026, titled “Focusing GvHD care through the eyes of providers and patients: Practical insights on ECP”. Here, we share a presentation by Hildegard Greinix, Austria, Vienna, describing her clinical experience in treating graft-versus-host disease (GvHD) with extracorporeal photopheresis (ECP).

Greinix presents two patient case studies, providing practical insights into the use of ECP for the treatment of acute GvHD (aGvHD) and chronic GvHD (cGvHD). In both cases, she explains that ECP could be considered as a second-line or later treatment option, either as monotherapy or in combination with other agents, owing to its immunomodulatory mechanism of action and favorable safety profile. She also explores key considerations and patient factors that inform treatment selection and initiation.

Clinical case 1: aGvHD

Greinix begins by presenting a clinical case of a fit 41-year-old male with myelodysplastic syndromes (MDS) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). On Day 45 post-transplant, he developed Grade 1 aGvHD involving the skin (Mount Sinai Acute GvHD International Consortium [MAGIC] Stage III) (Figure 1). Initial management consisted of topical corticosteroids. As symptoms progressed, subsequent diagnostic work‑up confirmed Grade 3 steroid‑refractory (SR)-aGvHD involving the liver and lower gastrointestinal tract (MAGIC Stage III). ECP was initiated on Day 126 post-transplant and incorporated as part of third‑line therapy in combination with cyclosporin A, systemic corticosteroids, and ruxolitinib. This combined approach enabled successful steroid tapering and complete resolution of SR-aGvHD on Day 205 post-transplant. ECP therapy was discontinued on Day 235.

Greinix also considers data from clinical studies of ECP for the treatment of aGvHD, including a retrospective study of patients with SR-aGvHD treated with ruxolitinib + ECP or ruxolitinib alone (Figure 2).¹

Key takeaways: 

• ECP can be considered as a second-line or later treatment option, alone or in combination with other agents, for patients with SR-aGvHD due to its immunomodulatory mechanism of action and favorable safety profile.^2–4
• As ECP does not cause generalized immunosuppression,^5–7 it may be used in patients with infections.

Clinical case 2: cGvHD

Greinix presents a second clinical case of a fit 63‑year‑old man with acute myeloid leukemia (AML) who underwent allo‑HSCT. On Day 123 post-transplant, he developed Grade 1 aGvHD with skin involvement (MAGIC Stage I–II) (Figure 3). aGvHD resolved with topical corticosteroids, after which the patient received three escalating doses of donor lymphocyte infusion (DLI). In July 2025, ECP was initiated in response to development of progressive sclerotic cGvHD, affecting the skin (National Institutes of Health [NIH] Stage III) and joints/fascia (NIH Stage II). Continuation of ECP enabled tapering of systemic corticosteroids and led to improvement in superficial sclerosis on the lower legs, while deep sclerosis of the ankles persisted (skin, NIH Stage III; joints/fascia, NIH Stage I). At the time of presentation, ECP was ongoing and administered over 2 consecutive days every 4 weeks.

Greinix also considers data from studies of ECP for the treatment of cGvHD, including a meta-analysis of ECP in SR-cGvHD, showing improved response rates observed after a longer treatment duration (ORR, 45.3% at 3–4 months and 58.2% at 6–8 months) supporting the long-term clinical effectiveness of ECP (Figure 4).⁸

Key takeaway: 

ECP can be considered as a second-line or later treatment option, alone or in combination with other agents, for patients with SR-cGvHD, particularly those with sclerodermatous SR-cGvHD – a setting where ECP has demonstrated benefit.^7,9