Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

TY - JOUR

T1 - Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

AU - Dignan, F. L.

AU - Aguilar, S.

AU - Scarisbrick, J. J.

AU - Shaw, B. E.

AU - Potter, M. N.

AU - Cavenagh, J.

AU - Apperley, J. F.

AU - Fielding, A. K.

AU - Pagliuca, Tony

AU - Raj, K.

AU - Marks, D. I.

AU - Peniket, A.

AU - Crawley, C.

AU - Koh, M. B.

AU - Child, F. J.

PY - 2014/5

Y1 - 2014/5

N2 - There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients' quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P = 0.012 and 3.4 compared with 6.9, P = 0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD.

AB - There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients' quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P = 0.012 and 3.4 compared with 6.9, P = 0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD.

KW - GVHD

KW - extracorporeal photopheresis

KW - quality of life

KW - VERSUS-HOST-DISEASE

KW - CONSENSUS DEVELOPMENT PROJECT

KW - BONE-MARROW-TRANSPLANTATION

KW - WORKING GROUP-REPORT

KW - T-CELL LYMPHOMA

KW - CLINICAL-TRIALS

KW - PHOTOCHEMOTHERAPY

KW - SURVIVORS

KW - CRITERIA

U2 - 10.1038/bmt.2014.21

DO - 10.1038/bmt.2014.21

M3 - Article

SN - 0268-3369

VL - 49

SP - 704

EP - 708

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

IS - 5

ER -