EXTRACORPOREAL PHOTOCHEMOTHERAPY FOR THE TREATMENT OF GRAFT-VERSUS-HOST DISEASE

Photopheresis is an extracorporeal photochemotherapy (ECP) used for th e treatment of oncological and autoimmune diseases, Lymphocytes are dr awn from the patients by leukapheresis, treated with 8-methoxypsoralen (8-MOP) and ultraviolet light A (UVA) in an extracorporeal system; th en, reinfused to the host, Because skin exposure to 8-MOP and UVA (PUV A) has been shown to improve cutaneous GVHD, we evaluated in a pilot s tudy, if ECP might be beneficial for patients with GVHD unresponsive t o conventional protocols, In this study, we enrolled 9 children or you ng adults, with acute (no.=1) or chronic extensive GVHD (no.=8). A sig nificant improvement was observed in three of the 5 patients with scle roderma-like lesions and in one patient with severe Liver involvement. Karnofsky performance score improved from 30-50% to 90% in the 4 resp onders, The better control of GVHD in these patients allowed a reducti on of the immunosuppressive therapy that was, finally, discontinued in two. No significant side effects were observed during ECP, Our result s suggest that ECP is a nonaggressive treatment that may benefit patie nts with c-GVHD unresponsive to standard immunosuppressive therapies.