Onkológia 6/2025
Extracorporeal photophoresis in treatment of Graft vs Host disease
Therapeutic process of a patient diagnosed with acute leukemia consists of many medical modalities. Chemotherapy, radiotherapy, immunotherapy, targeted therapy. There is a particular group of patients, indicated based on disease risk group, effectiveness of previous therapy and performance status, for which an allogenic stem cell transplant is necessary. After bone marrow transplantation, besides healthy engraftment, it is expected for graft vs leukemia (GvL) effect to occur. Similarly, it is beneficial for a patient to develop some level of graft vs host disease (GvHD) – Grade I-II, as a disease relaps prevention. Higher grades of GvHD are dangerous and require intensive and prompt treatment. Acute GvHD (aGvHD) is characterized by inflammation, chronic GvHD (cGvHD) displays signs of fibrosis and autoimmune disease. Chronic GvHD typically develops 100 days after transplantation and demands longer therapy. Nowadays there are various options to affect GvHD. Different types of imunosuppressants, Janus / Bruton kinase inhibitors, protein kinase inhibitors, as well as leukapheresis based procedure – extracorporeal photophoresis (ECP). ECP is safe, spares a patient many infectious complications and reduces toxicity of medications listed above. The intention is to reduce the amount of imunosuppressants, taper the periods between each ECP cycles, induce GvHD remission and improve patient's quality of life. To ensure that the ECP method is safe and effective for the patient, standardization of procedures is recommended. In this article, we provide an overview of the current recommendations for the use of ECP in the treatment of GvHD from various expert groups.
Keywords: extracorporeal photophoresis, graft versus host disease, bone marrow transplantation, imunosupression, lymphocytes, leukapheresis, steroid refractory, steroid dependent
