Should we use Extracorporeal Photopheresis more often? Evidence from Graft-Versus-Host Disease Patients Monitored with Treg as a Biomarker

Abstract

Background: Chronic graft-versus-host disease (cGvHD) is a major complication after allogeneic hematopoietic cell transplantation. Extracorporeal photopheresis (ECP) is an immunotherapy treatment for cGvHD, although suitable response biomarkers are lacking. Materials & methods: We analyzed data from six cGvHD patients undergoing ECP at a reference center from 826 to 2866 days. Circulating Tregs were enumerated, patient’s clinical evolution, immunosuppression dose and adverse events (AEs) registered. Results: We observed an increase in Tregs, a decrease in immunosuppression dosage and symptoms improvement. Mild AEs occurred at a very low rate. Conclusion: In these patients, the improvement of cGvHD, with low AEs, confirms a place for ECP as treatment. Improvements were accompanied by an increase in circulating Tregs, suggesting their role as a biomarker.

Lay abstract

Hematopoietic stem cell transplant is a lifesaving treatment, involving collecting blood-forming cells from a healthy donor and infusing them into a patient. Donor immune cells may attack patient tissues causing severe complications, including death (graft-versus-host disease [GvHD]). Primary treatment for GvHD are steroids. Extracorporeal photopheresis (ECP) is an alternative treatment that induces immunological tolerance, in part, due to Treg. We studied both clinical response and circulating Treg in six patients treated with ECP for up to 8 years. ECP responding patients had less GvHD, reduced the dose of steroids and increased the number of Treg.

Keywords:

• ECP
• extracorporeal photopheresis
• GvHD
• immunotherapy
• Treg

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Corrigendum

Author contributions

SM Lopes contributed to study design, acquisition, analysis and interpretation of data, drafting and revision of the manuscript; S Roncon contributed to study design, interpretation of data and revision of the manuscript; AC Pinho contributed to acquisition and interpretation of data; F Bordalo contributed to acquisition and interpretation of data; L Antunes contributed to statistical data; F Campilho contributed to clinical data; A Campos contributed to clinical data and A Costa-Pereira contributed to study design, interpretation of data and revision of the manuscript.

Financial & competing interests disclosure

This article was supported by National Funds through FCT – Fundação para a Ciência e a Tecnologia, I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.