Treatment of graft-versus-host disease by extracorporeal photochemotherapy: a pilot study.

Abstract:

BACKGROUND:Graft-versus-host disease (GVHD) is a major complication after bone marrow transplantation, which may be refractory to immunosuppressive drugs. As preliminary case reports suggested that extracorporeal photochemotherapy (ECP) using a Therakos device might be beneficial, we conducted a pilot study to assess the efficacy and safety of a new ECP method that does not require administration of 8-methoxypsoralen (8-MOP) to the patient. METHODS:ECP was performed three times a week for 3 weeks and then tapered according to the patient's course. Soluble 8-MOP was added ex vivo to an enriched mononuclear cell suspension obtained by a cell separator. This cellular suspension was then ultraviolet A irradiated and reinfused into the patient. Evaluation was performed using specific objective tests depending on clinical conditions. RESULTS:The two patients in the study with acute GVHD and severe liver dysfunction resistant to steroid pulse showed no improvement with ECP treatment. The five patients with chronic GVHD (c-GVHD) had the following clinical features: three patients had myositis and two patients had severe cutaneous c-GVHD, including one patient with sclerodermoid lesions, one with bronchiolitis obliterans, one with bronchitis, and one with liver involvement. Immunosuppressive drugs were either prohibited or ineffective. The number of procedures for each patient ranged from 13 to 30. Cytapheresis required the use of a double-lumen catheter (4/5) or an arteriovenous fistula (1/5). No side effects were related to 8-MOP or ultraviolet A irradiation. Four of five patients improved after ECP; one patient with bronchiolitis obliterans, a fibrotic condition, remained stable. CONCLUSIONS:ECP treatment may be helpful for the treatment of severe c-GVHD and the avoidance of increased immunosuppression.

journal_name

Transplantation

journal_title

Transplantation

authors

Besnier DP,Chabannes D,Mahé B,Mussini JM,Baranger TA,Muller JY,Milpied N,Esnault VL

doi

10.1097/00007890-199707150-00010

subject

Has Abstract

pub_date

1997-07-15 00:00:00

pages

49-54

issue

1

eissn

0041-1337

issn

1534-6080

journal_volume

64

pub_type

杂志文章
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    更新日期:2010-06-15 00:00:00

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    authors: Jiang J,Salido EC,Guha C,Wang X,Moitra R,Liu L,Roy-Chowdhury J,Roy-Chowdhury N

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    更新日期:1993-05-01 00:00:00

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    authors: Alfrey EJ,Friedman AL,Grossman RA,Perloff LJ,Naji A,Barker CF,Montone KT,Tomaszewski JE,Chmielewski C,Holland T

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    doi:

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    更新日期:1995-12-15 00:00:00

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    journal_title:Transplantation

    pub_type: 临床试验,杂志文章

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

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    pub_type: 杂志文章

    doi:10.1097/TP.0b013e318250fc25

    authors: Massicotte L,Denault AY,Beaulieu D,Thibeault L,Hevesi Z,Nozza A,Lapointe R,Roy A

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  • Failure patterns of cryopreserved vein grafts in liver transplantation.

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    pub_type: 杂志文章,评审

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    authors: Kuang AA,Renz JF,Ferrell LD,Ring EJ,Rosenthal P,Lim RC,Roberts JP,Ascher NL,Emond JC

    更新日期:1996-09-27 00:00:00

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    pub_type: 杂志文章

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  • VEGF-A and -C but not -B mediate increased vascular permeability in preserved lung grafts.

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    pub_type: 杂志文章

    doi:10.1097/00007890-200206150-00003

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    更新日期:2002-06-15 00:00:00

  • Tolerance induction in a large-animal model using total lymphoid irradiation and intrathymic bone marrow.

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    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181910e67

    authors: Horton PJ,Hawthorne WJ,Walters S,Patel T,Stewart GJ,Allen RD,Chapman JR

    更新日期:2008-12-27 00:00:00

  • Transplantation of autoimmune potential. II. Glomerulonephritis in lethally irradiated DBA/2 recipients of NZB bone marrow cells.

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    pub_type: 杂志文章

    doi:

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    更新日期:1975-06-01 00:00:00

  • B-cell concentration in the apheretic product predicts acute graft-versus-host disease and treatment-related mortality of allogeneic peripheral blood stem cell transplantation.

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    pub_type: 杂志文章

    doi:10.1097/TP.0b013e3181622e36

    authors: Iori AP,Torelli GF,De Propris MS,Milano F,Pupella S,Gozzer M,Mancini F,Milani ML,Intoppa S,Cerretti R,Lucarelli B,Valle V,Malandruccolo L,Iannella E,Arleo E,Guarini A,Foà R

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    doi:10.1097/01.TP.0000101495.22734.07

    authors: Ciancio G,Burke GW,Gaynor JJ,Mattiazzi A,Roth D,Kupin W,Nicolas M,Ruiz P,Rosen A,Miller J

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  • A prospective randomized trial comparing sequential ganciclovir-high dose acyclovir to high dose acyclovir for prevention of cytomegalovirus disease in adult liver transplant recipients.

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    journal_title:Transplantation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00007890-199410150-00005

    authors: Martin M,Mañez R,Linden P,Estores D,Torre-Cisneros J,Kusne S,Ondick L,Ptachcinski R,Irish W,Kisor D

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    更新日期:2003-07-15 00:00:00

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    doi:10.1097/01.tp.0000179640.06825.bf

    authors: Hack N,Angra S,McKnight TL,den Hollander N,Cardella CJ

    更新日期:2005-11-15 00:00:00

  • Plasma exchange for recurrent nephrotic syndrome following renal transplantation.

    abstract::Patients with steroid-resistant nephrotic syndrome and focal segmental glomerulosclerosis (FGS) who develop end-stage renal disease are at risk for recurrence of the disease following renal transplantation. Recurrence of the nephrotic syndrome in renal allografts of two children with primary FGS was successfully contr...

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    pub_type: 杂志文章

    doi:10.1097/00007890-198810000-00014

    authors: Laufer J,Ettenger RB,Ho WG,Cohen AH,Marik JL,Fine RN

    更新日期:1988-10-01 00:00:00