Extracorporeal photopheresis for graft-vs-host disease: A literature review and treatment guidelines proposed by the Nordic ECP Quality Group.

Autor: Nygaard M; Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Wichert S; Department of Haematology, Skåne University Hospital in Lund, Lund, Sweden., Berlin G; Department of Clinical Immunology and Transfusion Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden., Toss F; Division of Clinical Immunology, Department of Clinical Microbiology, Umeå University, Umeå, Sweden.; Department of Integrative Medical Biology, Umeå University, Umeå, Sweden.
Jazyk: angličtina
Zdroj: European journal of haematology [Eur J Haematol] 2020 May; Vol. 104 (5), pp. 361-375. Date of Electronic Publication: 2020 Feb 22.
DOI: 10.1111/ejh.13381
Abstrakt: Extracorporeal photopheresis (ECP) is one of the most used and established therapies for steroid-refractory graft-vs-host disease (GvHD), with a good effect to side effect profile. In this review, we present a summary of present literature and provide evidence-based treatment guidelines for ECP in GvHD. The guidelines constitute a consensus statement formed by the Nordic ECP Quality Group representing all ECP centres in the Nordic countries, and aims to facilitate harmonisation and evidence-based practice. In developing the guidelines, we firstly conducted a thorough literature search of original articles and existing guidelines. In total, we identified 26 studies for ECP use in acute GvHD and 36 in chronic GvHD. The studies were generally small, retrospective and heterogeneous regarding patient characteristics, treatment schedule and outcome assessment. In general, a majority of patients achieved partial response or better, but response rates varied by the organs affected. Head-to-head comparisons to other treatment modalities were lacking. Overall, we consider the quality of evidence to be low-moderate (GRADE) and encourage future prospective multi-armed trials to strengthen the present recommendations. However, despite limitations in evidence strength, standardised treatment schedules and regular follow-up are imperative to ensure the best possible patient outcome.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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