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. 2022 Aug 4;10(8):1887.
doi: 10.3390/biomedicines10081887.

Effective Extracorporeal Photopheresis of Patients with Transplantation Induced Acute Intestinal GvHD and Bronchiolitis Obliterans Syndrome

Robin Reschke  1   2 , Stephanie Zimmerlich  2 , Christine Döhring  3 , Gerhard Behre  4 , Mirjana Ziemer  2
Affiliations

Effective Extracorporeal Photopheresis of Patients with Transplantation Induced Acute Intestinal GvHD and Bronchiolitis Obliterans Syndrome

Robin Reschke et al. Biomedicines. .

Abstract

Background: Patients with steroid-refractory intestinal acute graft-versus-host disease (aGvHD) and bronchiolitis obliterans syndrome (BOS) represent a population with a high need for alternative and effective treatment options. Methods: We report real-life data from 18 patients treated with extracorporeal photopheresis (ECP). This cohort consisted of nine patients with steroid-refractory intestinal aGvHD and nine patients with BOS. Results: We document partial or complete clinical response and reduction of symptoms in half of the patients with intestinal acute GvHD and patients with BOS treated ECP. Responding patients tended to stay on treatment longer. In patients with BOS, stabilization of lung function and forced expiratory volume was observed, whereas, less abdominal pain, less diarrhea, and a reduction of systemic corticosteroids were seen in patients with intestinal acute GvHD. Conclusions: ECP might not only abrogate symptoms but also reduce mortality caused by complications from high-dose steroid treatment. Taken together, ECP offers a serious treatment avenue for patients with steroid-refractory intestinal acute GvHD and BOS.

Keywords: acute intestinal graft-versus-host disease; bronchiolitis obliterans syndrome; extracorporeal photopheresis.

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Conflict of interest statement

M.Z. received honoraria for lectures from Therakos Deutschland GmbH (Mallinckrodt Pharmaceuticals).

Figures

Figure 1
Figure 1
Patient with CR and significantly less diarrhea and usage of systemic steroids. The patient reported a decrease in abdominal pain during ECP.
Figure 2
Figure 2
Patient with partial response. Significant reduction of diarrhea and steroid usage during ECP treatment. End of ECP marked with a vertical gray line.
Figure 3
Figure 3
Patient with NR. Corticosteroids had to be increased during ECP due to hematochezia. Diarrhea decreased over time but no significant treatment response was observed in this patient.
Figure 4
Figure 4
Complete response of a patient with BOS to ECP. Lung function and FEV1 stabilized.
Figure 5
Figure 5
BOS patient with objectifiable but not significant response during ECP.
Figure 6
Figure 6
BOS patient without response and decreasing lung function during ECP.
See this image and copyright information in PMC

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