2022 EBMT Extracorporeal photodissociation therapy - a case study of chronic GVHD based on new experience

Study Introduction Extracorporeal photopheresis (ECP) is an apheresis-based immunomodulatory treatment in which leukocytes isolated from a patient are treated with the photoactivator methoxypsoralen and treated with long-wavelength ultraviolet (UVA) light.
Irradiation, followed by reinfusion, produces immunosuppressive effects as a complementary therapy for chronic graft-versus-host disease (GVHD)
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At the researcher's bone marrow transplant institution, the researcher began to carry out hematopoietic stem cell transplantation (HSCT) in 2000, and has performed more than 600 interventions so far.
After recognizing the therapeutic potential of ECP therapy, the center will start in 2021.
Carry out ECP therapy
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To date, investigators have performed 38 ECP treatments, 22 (58%) with peripheral venous access and 16 (42%) with only central venous access
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No serious adverse events have been identified to date
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The investigators treated three patients with chronic GVHD and attempted to treat one patient with non-Hodgkin's lymphoma-peripheral T-cell lymphoma
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Unfortunately, only 1 patient with chronic GVHD performed the entire treatment regimen
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This patient, a 24-year-old male, was diagnosed with severe aplastic anemia (SAA) in 2017; in 2018, unrelated allogeneic HSCT was successful
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But in May 2019, there was stomach pain and yellowing of the skin
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Whole blood cell (CBC) hemoglobin (Hgb) 119 g/L, WBC 11.
2*109/L, platelet (PLT) 247*109/L
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Aspartate aminotransferase (AST) 238 U/L, alanine aminotransferase (ALT) 178 U/L, AP 800 U/L, glutamyl transferase (GGT) 1996 U/L, lactate dehydrogenase (LDH) 691 U/ L, total bilirubin 209 µmol/L, direct bilirubin 126 µmol/L, indirect bilirubin 83 µmol/L
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Grafts were fully chimeric; HBV and HCV were excluded
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Liver biopsy showed chronic GVHD of the liver
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The investigators used methylprednisolone + cyclosporine A as first-line therapy, but only achieved partial remission, AST 137 U/L, ALT 280 U/L, AP 588 U/L, GGT 1756 U/L, total bilirubin 53 µmol/L, direct bilirubin 25 µmol/L, indirect bilirubin 28 µmol/L
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The investigators used four doses of rituximab as second-line therapy and mycophenolate mofetil as third-line therapy, but results remained similar (AST 146 U/L, ALT 238 U/L, AP 880 U/L, GGT 1200 U/L L, LDH 390 U/L, total bilirubin 92 µmol/L, direct bilirubin 87 µmol/L, indirect bilirubin 5 µmol/L)
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For fourth-line therapy, the investigators used ECP alone
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The treatment regimen consisted of 2 interventions on 2 consecutive days per cycle, every 2 weeks as a cycle for 4 months, after which it changed to every 4 weeks
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All interventions were successfully completed without adverse events
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The investigators used only peripheral venous access
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The patient's current CBC blood count is normal, AST 51 U/L, ALT 55 U/L, AP 400 U/L, GGT 250 U/L, total bilirubin 22 µmol/L, direct bilirubin 12 µmol/L, indirect Bilirubin 10 µmol/L was stable, with slight regression of skin changes associated with chronic GVHD
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Conclusion This successful treatment case motivated researchers to continue to adhere to the ECP strategy and demonstrated the therapeutic potential of ECP
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In the future, investigators will implement ECP in some patients, even early in the treatment plan, mainly in patients with chronic GVHD
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REFERENCES: L.
Chadievski, I.
Panovska Stavridis, B.
Georgievski, et al.
EXTRACORPOREAL PHOTOPHERESIS- A CASE BASED NEW EXPERIENCE IN TREATING CHRONIC GVHD.
EBMT P267.
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