Recent insights into extracorporeal photopheresis for graft-versus-host disease

Figures & data

Figure 1. ECP procedure and hypothesized mechanism of action. Step 1: Mononuclear cells (MNCs) are separated by peripheral blood by an apheresis cell separator. Step 2: MNCs are incubated with 8-methoxy psoralen that cross-links DNA bases after photoactivation by UV-A rays. The treatment induces cell apoptosis, maturation of tolerogenic dendritic cells (DC), and phagocytosis of apoptotic lymphocytes by DC. The process dampens inflammation by reducing pro-inflammatory cytokines, enhancing anti-inflammatory cytokines production, and promoting the expansion of Tregs which, in turn, produce anti-inflammatory cytokines. Step 3: treated cells are returned to the patient and 8-methoxypsoralen is inactive¹.

Table 1. Published studies on aGvhd and cGvhd patients treated by ECP.

Author, year	Study design	N Patients	Setting	Response (RR/CR)
Messina, 2003	Retrospective, multicenter	77 33 aGvHD 44 cGvHD	Pediatric	aGvHD RR 75%, CR 54% cGvHD RR 73%, CR 44%
Greinix,2006	Prospective, single arm	59 aGvHD	Adult	RR 70%, CR 60%
Couriel, 2006	Retrospective, single center	71 cGvHD	Adult	RR 61%, CR 20%
Flowers, 2008	Prospective, randomized, multicenter trial	95 (48 vs 47) cGvHD	Adult	RR 40% vs 10% in skin (12th week)
Jagasia, 2009	Retrospective, multicenter	63 20 aGvHD 43 cGvHD	Adult	aGvHD RR 45%, CR 10% cGvHD RR 58%, CR 11%
Perotti, 2010	Retrospective, single center	73 50 aGvHD 23 cGvHD	Pediatric	aGvHD RR 68%, CR 32% cGvHD RR 70%, CR 21.7%
Del Fante, 2012	Retrospective, single center	102 cGvHD	Adult	RR 80.5, CR 15.7%
Das-Gupta, 2014	Retrospective, multicenter	128 aGvHD	Adult	RR 77%, CR 67%
Calore, 2015	Retrospective, single center	72 aGvHD	Pediatric	RR 83%, CR 64%
Malagola, 2016	Retrospective multicenter	94 45 aGvHD 49 cGvHD	Adult	aGvHD RR n.a., CR 91% cGvHD RR 80%, CR 45%
Worel, 2018	Retrospective, single center	99 aGvHD	Adult	RR 75% CR 53%
Gandelman, 2018	Prospective, multicenter	77 cGvHD	Adult	RR 62%, CR 14%
Niittyvuopio,2018	Retrospective, single center	52 aGvHD	Adult	RR 62%, CR 48%
Sakellari, 2018	Prospective, single center	109 21 aGvHD 88 cGvHD	Adult	aGvHD RR 84%, CR 5% cGvHD RR 73%, CR 42.6%
Oarbeascoa, 2020	Retrospective, multicenter	113 65 aGvHD 48 cGvHD	Adult and pediatric	aGvHD RR 53%,CR 45% cGvHD RR 67%, CR 23%
Batgi, 2021	Retrospective, multicenter	75 aGvHD	Adult and pediatric	RR 43%, CR 43%
Amat, 2021	Prospective, multicenter	62 37 aGvHD 25 cGvHD	Adult	aGvHD RR 73%, CR 40.5% cGvHD RR 88%, CR 24%
Mehta, 2021	Randomized, adaptive, trial	81 a GvHD (51 vs 30)	Adult	RR 74.5% vs 56.7% at day 28
Asensi-Canto,’ 2022	Retrospective, single center	33 24 aGvHD 9 cGvHD	Pediatric	aGvHD RR 66%, CR 52% cGvHD RR 50%, CR 20%
Asensi-Canto,’ 2023	Retrospective, single center	83 aGvHD 28 cGvHD 54	Adult	aGvHD RR 61%, CR 57% cGvHD RR 87% CR 39%
Linn, 2023	Retrospective, single center	75 cGvHD	Adult and pediatric	RR 57%-70% (6–12 monts),