Blood Res.  2014 Jun;49(2):100-106. 10.5045/br.2014.49.2.100.

Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis

• Malik MI
• Litzow M
• Hogan W
• Patnaik M
• Murad MH
• Prokop LJ
• Winters JL
• Hashmi S

• KMID: 2172805
• DOI: http://doi.org/10.5045/br.2014.49.2.100

Abstract

BACKGROUND
The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies.
METHODS
We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ-specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates.
RESULTS
Pooled CR rates and ORR were 29% (confidence interval [CI], 19-42%) and 64% (CI, 65-82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29-70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies.
CONCLUSION
ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.

Keyword

Graft-versus-host disease; Extracorporeal photopheresis; Meta-analysis

MeSH Terms

Adult
Appointments and Schedules
Graft vs Host Disease*
Humans
Liver
Lung
Patient Selection
Photopheresis*
Population Characteristics
Skin

Figure

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  Fig. 1 Identification and selection of studies for steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Default criteria for cGVHD diagnosis were based on the NIH consensus criteria as below: Diagnosis of cGVHD requires the presence of at least 1 diagnostic clinical sign of cGVHD or the presence of at least 1 distinctive manifestation confirmed by pertinent biopsy or other relevant tests in the same or another organ [13].

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  Fig. 2 Forest plot of the complete response rates following extracorporeal photopheresis for chronic graft-versus-host disease.

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  Fig. 3 Forest plot of the overall response rates following extracorporeal photopheresis for chronic graft-versus-host disease.

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