Successful Extracorporeal Photochemotherapy for Chronic Graft-Versus-Host Disease in Pediatric Patients
| Autor: | Marc G. Berger, Chantal Rapatel, Lionel de Lumley, Pierre Bordigoni, Jean Louis Stephan, Justyna Kanold, Catherine Paillard, Pascale Halle, Christophe Piguet, Michel D'Incan, François Demeocq |
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| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Immunology Graft vs Host Disease Disease medicine Extracorporeal photochemotherapy Humans Transplantation Homologous Prospective Studies Child Salvage Therapy business.industry Hematopoietic Stem Cell Transplantation Hematology medicine.disease Surgery Survival Rate Treatment Outcome surgical procedures operative Graft-versus-host disease Child Preschool Hematologic Neoplasms Photopheresis Chronic Disease Costs and Cost Analysis Feasibility Studies Female business |
| Zdroj: | Journal of Hematotherapy & Stem Cell Research. 11:501-512 |
| ISSN: | 1525-8165 |
| DOI: | 10.1089/15258160260090960 |
| Popis: | A total of 254 extracorporeal photochemotherapy (ECP) procedures were performed in 8 children (median age 10 years; range 5-15) with extensive resistant chronic graft-versus-host disease (GVHD). ECP was carried out in the pediatric environment using a Cobe Spectra separator and UV-MATIC irradiator. A peripheral venous with a single-lumen permanent central catheter access (69% of ECP-apheresis) or a dual-lumen permanent central catheter access (26% of ECP-apheresis) were used preferentially. A median platelet decrease of 17% (0-71) (p = 0.0001) and median hemoglobin level decrease of 15 g/L (0-31)(p = 0.0001) were noted following each ECP-apheresis. However, none of the patients had profound thrombocytopenia or anemia. Two minor episodes of catheter related-bacteriemia (Staphylococcus aureus) were noted (2310 catheter-days). A negative correlation was found between lymphocyte collection efficacy (median = 38%) and pre ECP-apheresis lymphocyte count (r = 0.4, p = 0.00001). The median of 5 x 10(7) lymphocytes/kg (0.1-50.10(7)/kg) was irradiated in each procedure. All patients are alive and well, and 7/8 experienced a dramatic improvement in their cutaneous status. Liver and gut disease resolved completely in 4/6 and 5/5 patients, respectively. In all patients, a concomitant immunosuppressive therapy was stopped (5/8) or considerably reduced (3/8). Five patients with more than 2 years follow-up after discontinuation of ECP are in remission with no immunosuppression treatment. They have normal growth rates and normal school and sport activity. Our study shows that ECP is beneficial, well tolerated, and can be safely used for chronic GVHD treatment even in young children with low body weight and a poor performance status. We believe that having a dedicated pediatric environment together with an experienced, motivated, and specifically pediatric team is of crucial importance for improving patient's acceptance of this long-term therapeutic program. |
| Databáze: | OpenAIRE |
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