Original Article
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Blood Res 2014; 49(2):
Published online June 25, 2014
https://doi.org/10.5045/br.2014.49.2.100
© The Korean Society of Hematology
Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis
1Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
2Division of Preventive, Occupation and Aerospace Medicine, Mayo Clinic, Rochester, USA.
3Library and Public Services, Mayo Clinic, Rochester, USA.
4Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
Correspondence to : Correspondence to Shahrukh Hashmi, M.D. MPH. Division of Hematology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: +1-507-293-2184, Fax: +1-507-284-4011, Hashmi.shahrukh@mayo.edu
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background
The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies.
Methods
We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ-specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates.
Results
Pooled CR rates and ORR were 29% (confidence interval [CI], 19-42%) and 64% (CI, 65-82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29-70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies.
Conclusion
ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.
Keywords Graft-versus-host disease, Extracorporeal photopheresis, Meta-analysis
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Original Article
Blood Res 2014; 49(2): 100-106
Published online June 25, 2014 https://doi.org/10.5045/br.2014.49.2.100
Copyright © The Korean Society of Hematology.
Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis
Mohsin Ilyas Malik1*, Mark Litzow1, William Hogan1, Mrinal Patnaik1, Mohammad Hassan Murad2, Larry J. Prokop3, Jeffrey L. Winters4, and Shahrukh Hashmi1*
1Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, USA.
2Division of Preventive, Occupation and Aerospace Medicine, Mayo Clinic, Rochester, USA.
3Library and Public Services, Mayo Clinic, Rochester, USA.
4Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
Correspondence to: Correspondence to Shahrukh Hashmi, M.D. MPH. Division of Hematology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Tel: +1-507-293-2184, Fax: +1-507-284-4011, Hashmi.shahrukh@mayo.edu
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) has been explored in multiple studies but reported response rates (RR) vary significantly across studies.
Methods
We conducted a meta-analysis to assess the efficacy of ECP for SR-cGVHD. A search of electronic databases for studies published between 1984 and 2012 was conducted. End points included RR: complete response (CR), overall response rates (ORR), and organ-specific RR. The initial search generated 312 studies, of which 18 met the selection criteria (N=595). A random effects model was used for pooled rates.
Results
Pooled CR rates and ORR were 29% (confidence interval [CI], 19-42%) and 64% (CI, 65-82%), respectively. One-year overall survival was available for 4 studies only and was 49% (CI, 29-70%). The pooled RR for skin, liver, ocular, oral, lung, gastrointestinal and musculoskeletal SR-cGVHD was 74%, 68%, 60%, 72%, 48%, 53%, and 64%, respectively. There was a significant heterogeneity among studies due to differences in ECP schedules and duration. No significant differences in responses to ECP for pediatric and adult populations were found. Sensitivity analysis could not be undertaken due to a limited number of prospective studies.
Conclusion
ECP is an effective therapy for oral, skin, and liver SR-cGVHD, with modest activity in lung and gastrointestinal SR-cGVHD.
Keywords: Graft-versus-host disease, Extracorporeal photopheresis, Meta-analysis
Fig 1.
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Identification and selection of studies for steroid-refractory chronic graft-versus-host disease (SR-cGVHD). Default criteria for cGVHD diagnosis were based on the NIH consensus criteria as below: Diagnosis of cGVHD requires the presence of at least 1 diagnostic clinical sign of cGVHD or the presence of at least 1 distinctive manifestation confirmed by pertinent biopsy or other relevant tests in the same or another organ [13].
Fig 2.
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Forest plot of the complete response rates following extracorporeal photopheresis for chronic graft-versus-host disease.
Fig 3.
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Forest plot of the overall response rates following extracorporeal photopheresis for chronic graft-versus-host disease.
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Table 1 . Quality of the selected studies..
a)ECP+ Standard therapy, b)Standard therapy, c)mean value..
Abbreviation: ECP, extracorporeal photopheresis..
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Table 2 . Response rates for steroid-refractory chronic graft-versus-host disease..
Abbreviations: CR, complete response rates; ORR, overall response rates; GI, gastrointestinal; MSK, musculoskeletal; BO, bronchiolitis obliterans..
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