Extracorporeal Photopheresis versus Anticytokine Therapy as a Second-Line Treatment for Steroid-Refractory Acute GVHD: A Multicenter Comparative Analysis

Abstract The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds rat...

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Published inBiology of blood and marrow transplantation Vol. 19; no. 7; pp. 1129 - 1133
Main Authors Jagasia, Madan, Greinix, Hildegard, Robin, Marie, Das-Gupta, Emma, Jacobs, Ryan, Savani, Bipin N, Engelhardt, Brian G, Kassim, Adetola, Worel, Nina, Knobler, Robert, Russell, Nigel, Socie, Gerard
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2013
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Summary:Abstract The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P  = .007), and grade >II aGVHD (odds ratio, 68; P < .001) were independent predictors of response. ECP therapy, adjusted for conditioning regimen intensity and steroid dose, was associated with superior survival (hazard ratio [HR], 4.6; P  = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P < .001) and lack of response to therapy (HR, 3.09; P  = .011) were associated with inferior survival. These findings require validation in a prospective randomized study.
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ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2013.04.018