Extracorporeal photopheresis and anticytokine therapy in the treatment of steroid-refractory acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation in children


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Allogeneic hematopoietic stem cell transplantation (allo-SCT) is used widely in the management of children with hematological, oncological and inherited diseases. Study to compare efficiency of steroid-refractory acute graft versus host disease treatment (extracorporeal photopheresis (ECP) vs anticytokine therapy) was conducted in Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of Saint Petersburg. Sixty four children were included in the analysis. Patients were divided into two groups: first “group with ECP” (n = 31; 50,5 %) ("ECP group") and second - "group without ECP" (n = 33; 49,5 %). Treatment in the second group consisted of anticytokine therapy (etanercept (n = 12), infliximab (n = 9), daclizumab (n = 8)) and alemtuzumab (n = 4). Ten-year overall survival (OS) of children with steroid-refractory acute graft versus host disease was 39 % without difference in OS between ECP and anticytokine therapy (5-year OS 40 % vs 35 %, p = 0,34). Response rate to the therapy was also the same in both groups (68 % after ECP and 70 % after anticytokine therapy, p = 0,77). Difference in cumulative incidence of relapse in "ECP group" and "group without ECP" was not statistically significant (18 % and 7 %, respectively, p = 0,2). In conclusion, ECP and anticytokine therapy are equally effective in the treatment of children with steroid-refractory acute graft versus host disease and are associated with the same cumulative incidence of relapse.

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Andrey Kozlov

First St. Petersburg State Medical University

Email: kozlovandrew@list.ru
MD, PhD, Resident Doctor. Bone Marrow Department No 2 Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Julia Fedukova

First St. Petersburg State Medical University

Email: vig1982@inbox.ru
Resident Doctor. Bone Marrow Department No 2 Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Tatzana Bykova

First St. Petersburg State Medical University

Email: dr.bykova@me.com
MD, PhD, Resident Doctor. Bone Marrow Department No 2 Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Ivan Moiseev

First St. Petersburg State Medical University

Email: moisiv@mail.ru
MD, PhD, Associate Professor, Head. Laboratory of Transplantology and Department of Biotechnology Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Marya Estrina

First St. Petersburg State Medical University

Email: estrina.ma@mail.ru
ssociate Professor, Head. Department of Clinical Transfusiology. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Irina Kulagina

First St. Petersburg State Medical University

Email: kulagina1965@inbox.ru
Department of Clinical Transfusiology. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Sergey Bondarenko

First St. Petersburg State Medical University

Email: dr.sergeybondarenko@gmail.com
MD, PhD, Deputy Director. The head of department. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Elena Morozova

First St. Petersburg State Medical University

Email: dr_morozova@mail.ru
MD, PhD, Associate Professor, Head. Department of Bone Marrow Transplantation N 2. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Anna Osipova

First St. Petersburg State Medical University

Email: md.annarats@gmail.com
Department of Bone Marrow Transplantation No 1. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Anastasya Borovkova

First St. Petersburg State Medical University

Email: bonastasya@mail.ru
Department of Bone Marrow Transplantation N 1. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Svetlana Razumova

First St. Petersburg State Medical University

Email: razymova_sv@mail.ru
Postgraduate Student. Department of Hematology, Transfusiology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Ludmila Zubarovskaya

First St. Petersburg State Medical University

Email: zubarovskaya_ls@mail.ru
MD, PhD, Dr Med Sci, Professor. The chief of Children Oncology, Hematology and Transplantation Department. State Budget Educational Institution “The First St. Petersburg State Medical University”.

Boris Afanasyev

First St. Petersburg State Medical University

Email: bvafan@gmail.com
MD, PhD, Dr Med Sci, Professor. Head of Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation. State Budget Educational Institution “The First St. Petersburg State Medical University”.

参考

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  7. Niederwieser D. 1 millionth blood stem cell transplant marks major medical milestone. Worldwide Network for Blood and Marrow Transplantation. 2013. Available at: http://globenewswire.com/news-release/2013/01/30/519544/10019770/en/1-Millionth-Blood-Stem-Cell-Transplant-Marks-Major-Medical-Milestone.html (accessed 11.11.2015).
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  11. Schub N, Günther A, Schrauder A, et al. Therapy of steroid-refractory acute GVHD with CD52 antibody alemtuzumab is effective. Bone Marrow Transplant. 2011;46:143-7.
  12. Uygun V, Daloglu H, Karasu G, et al. Safety and Outcomes of Extracorporeal Photopheresis With the Therakos Cellex System for Graft-Versus-Host Disease in Pediatric Patients. J of Pediatric Hemato-logy/Oncology.2015;37(3):209-14. doi: 10.1097/mph.0000000000000282.
  13. Westin JR, Sliba RM, De Lima M, et al. Steroid refractory acute GVHD: Predictors and outcomes. Advances in Hematology. 2011. doi: 10.1155/2011/601953

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版权所有 © Kozlov A.V., Fedukova J.G., Bykova T.A., Moiseev I.S., Estrina M.A., Kulagina I.I., Bondarenko S.N., Morozova E.V., Osipova A.A., Borovkova A.S., Razumova S.V., Zubarovskaya L.S., Afanasyev B.V., 2016

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