The Use of Extracorporeal Photopheresis for the Treatment of Acute Graft Versus Host Disease

Acute graft versus host disease (aGVHD) is a key complication of haematopoietic stem-cell transplantation. The main first-line therapy is steroids, however less than half of patients respond to this treatment, and some patients relapse following an initial response. Extracorporeal photopheresis (ECP) is a therapy that has shown promising efficacy in several immune-mediated disorders, including aGVHD. Used as a second-line treatment, ECP has been associated with good rates of disease resolution, both overall and for individual organ systems involved in this disorder. The responses to ECP have commonly been seen soon after the start of treatment. Patients who respond to ECP have also been shown to have lower rates of transplant-related mortality and greater overall survival than those who do not respond. ECP is well tolerated by patients, including those with a low performance index and children of low body weight. Data on the use of ECP in treating aGVHD in both adults and children are reviewed here.