Long-term extracorporeal photoimmunotherapy for treatment of chronic cutaneous graft-versus-host disease: Observations in four patients

Background: Chronic cutaneous graft-versus-host disease (GvHD) can arise as a late complication after allogeneic bone marrow transplantation. Patients with extensive disease to date require intensive early and long-term immun osuppression; however, treatment is often insufficient. Since the beneficia l effects of phototherapy for chronic cutaneous GVHD are well known, extrac orporeal photoimmunotherapy (ECP) was also tried with some success for a fe w single patients with this disease. Objective: The long-term effect of ECP was evaluated in 4 patients with therapy-resistant severe chronic cutaneou s GvHD after allogeneic bone marrow transplantation. Methods: Four patients were treated with monthly sessions of ECP over a period of 16-40 months. D isease severity was assessed by a semiquantitative score adapted from the l iterature including extent of skin area involved, rigidity of the skin, inv olvement of joints and immunosuppressive drug consumption. Results: In all patients, a favorable response was observed after 6-12 treatment cycles. On e patient had a complete response, 2 patients had a partial response, and 1 patient had a minor response after treatment. In 2 patients, immunosuppres sive medication started before initiating ECP could be reduced or completel y withdrawn under ECP. Peripheral blood lymphocyte immunophenotyping reveal ed reduction of CD3+ CD4+ T cells in 3 patients and of elevated CD3+ CD8+ a nd CD57+ CD8+ T cell subsets in 2 patients. Conclusion: ECP is effective in treating severe chronic cutaneous GvHD. ECP possibly exerts its effects by reducing the number of CD8+ suppressor/cytotoxic T cells, the presumptive effector cells of GvHD. ECP is well tolerated with essentially no side effe cts and allows reducing the dosage of immunosuppressive agents.