Systematic review and meta-analysis of prospective studies for ECP treatment in patients with steroid-refractory acute GVHD

Figures & data

Figure 1 Identification and selection of studies for steroid-refractory acute graft-versus-host disease.

Abbreviations: aGVHD, acute graft-versus-host disease; ECP, extracorporeal photopheresis; GVHD, graft-versus-host disease; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

Table 1 Characteristics of the included studies

Study	Design	Number	Complete response number	Overall response number	Skin response	Liver response	Gut response	Primary disease	ECP system
Smith et al^Citation12	Prospective	6	0	0	0	0	0	CML, AL, AA, MDS	Therakos Uvar XTS
Salvaneschi et al^Citation13	Prospective	9	5	17	8 (9)	1 (3)	3(5)	Leukemia, thalassemia major, SAA	Cobe Spectra
Garban et al^Citation14	Prospective	12	–	9	10 (12)	0 (2)	3(5)	AL, CML, MM, MDS, myeloproliferative disease, Fanconi’s anemia, solid tumor	Cobe Spectra
Greinix et al^Citation18	Prospective	59	41	–	47 (57)	14 (23)	9 (15)	AML, ALL, CML, others	Therakos Uvar XTS
Kanold et al^Citation15	Prospective	12	7	10	10 (10)	6 (9)	5 (6)	ALL, AML, SAA CML, NHL, others	Cobe Spectra
Calore et al^Citation16	Prospective	15	13	15	12 (13)	1 (1)	10 (14)	AML, ALL, NHL	Cobe Spectra
Ussowicz et al^Citation17	Prospective	8	–	3	–	–	–	AML, ALL, CML, MM, SAA ALCL	Therakos Uvar XTS

Notes: Data in response columns is: number of responders (total number involved).

Abbreviations: AA, aplastic anemia; AL, acute leukemia; AML, acute myelogenous leukemia; ALL, acute lymphoblastic leukemia; ALCL, anaplastic large cell lymphoma; CML, chronic myelogenous leukemia; ECP, extracorporeal photopheresis; MDS, myelodysplastic syndrome; SAA, severe aplastic anemia; MM, multiple myeloma; NHL, non-Hodgkin lymphoma.

Table 2 Quality of included studies

Study	Representativeness of study sample	Ascertainment of exposure	Demonstration outcome was not present at start	Attribution bias minimized	Detection bias minimized	Follow-up time appropriate
Smith et al^Citation12	Yes	Yes	Yes	Yes	Yes	Unclear
Salvaneschi et al^Citation13	No	Yes	Yes	Yes	Unclear	Yes
Garban et al^Citation14	Yes	Yes	Yes	Yes	Unclear	Unclear
Greinix et al^Citation18	No	Yes	Yes	Yes	Unclear	Yes
Kanold et al^Citation15	No	Yes	Yes	Yes	Unclear	Yes
Calore et al^Citation16	No	Yes	Yes	Yes	Unclear	Yes
Ussowicz et al^Citation17	No	Yes	Yes	Yes	Unclear	Unclear

Figure 2 Overall response rate of ECP in the treatment of SR-aGVHD.

Note: Weights are from random-effects analyses.
Abbreviations: CI, confidence interval; ECP, extracorporeal photopheresis; ES, effect size; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

Figure 3 Complete response rate of ECP in the treatment of SR-aGVHD.

Note: Weights are from random-effects analyses.
Abbreviations: CI, confidence interval; ECP, extracorporeal photopheresis; ES, effect size; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

Figure 4 (A) Efficacy of ECP for skin SR-aGVHD, (B) funnel plot with pseudo 95% confidence limits.

Note: Weights are from random-effects analyses.
Abbreviations: CI, confidence interval; ECP, extracorporeal photopheresis; ES, effect size; SE, standard error; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

Figure 5 (A) Efficacy of ECP for liver SR-aGVHD, (B) funnel plot with pseudo 95% confidence limits.

Note: Weights are from random-effects analyses.
Abbreviations: CI, confidence interval; ECP, extracorporeal photopheresis; ES, effect size; SE, standard error; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

Figure 6 (A) Efficacy of ECP for gut SR-aGVHD, (B) funnel plot with pseudo 95% confidence limits.

Note: Weights are from random-effects analyses.
Abbreviations: CI, confidence interval; ECP, extracorporeal photopheresis; ES, effect size; SE, standard error; SR-aGVHD, steroid-refractory acute graft-versus-host disease.

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