ECP versus ruxolitinib in steroid-refractory chronic GVHD - a retrospective study by the EBMT transplant complications working party.
Journal
Bone marrow transplantation
ISSN: 1476-5365
Titre abrégé: Bone Marrow Transplant
Pays: England
ID NLM: 8702459
Informations de publication
Date de publication:
06 Jan 2024
06 Jan 2024
Historique:
received:
24
08
2023
accepted:
01
12
2023
revised:
13
11
2023
medline:
7
1
2024
pubmed:
7
1
2024
entrez:
6
1
2024
Statut:
aheadofprint
Résumé
Ruxolitinib has become the new standard of care for steroid-refractory and steroid-dependent chronic GVHD (SR-cGVHD). Our aim was to collect comparative data between ruxolitinib and extracorporeal photophoresis (ECP). We asked EBMT centers if they were willing to provide detailed information on GVHD grading, -therapy, -dosing, -response and complications for each included patient. 31 centers responded positively and we included all patients between 1/2017-7/2019 treated with ECP or ruxolitinib for moderate or severe SR-cGVHD. We identified 84 and 57 patients with ECP and ruxolitinib, respectively. We performed multivariate analyses adjusted on grading and type of SR-cGVHD (steroid dependent vs. refractory vs. intolerant to steroids). At day+180 after initiation of treatment for SR-cGVHD the odds ratio in the ruxolitinib group to achieve overall response vs. the ECP group was 1.35 (95% CI = [0.64; 2.91], p = 0.43). In line, we detected no statistically significant differences in overall survival, progression-free survival, non-relapse mortality and relapse incidence. The clinical significance is limited by the retrospective study design and the current data can't replace prospective studies on ECP in SR-cGVHD. However, the present results contribute to the accumulating evidence on ECP as an effective treatment option in SR-cGVHD.
Identifiants
pubmed: 38184740
doi: 10.1038/s41409-023-02174-2
pii: 10.1038/s41409-023-02174-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Passweg JR, Baldomero H, Chabannon C, Basak GW, Corbacioglu S, Duarte R et al. The EBMT activity survey on hematopoietic-cell transplantation and cellular therapy 2018: CAR-T’s come into focus. Bone Marrow Transplant 2020. e-pub ahead of print 2020/02/19; https://doi.org/10.1038/s41409-020-0826-4 .
Bhatt VR, Wang T, Chen K, Kitko CL, MacMillan ML, Pidala JA, et al. Chronic Graft-versus-Host Disease, Nonrelapse Mortality, and Disease Relapse in Older versus Younger Adults Undergoing Matched Allogeneic Peripheral Blood Hematopoietic Cell Transplantation: A Center for International Blood and Marrow Transplant Research Analysis. Transpl Cell Ther. 2022;28:34–42. https://doi.org/10.1016/j.jtct.2021.10.002 . e-pub ahead of print 20211009.
doi: 10.1016/j.jtct.2021.10.002
Penack O, Marchetti M, Ruutu T, Aljurf M, Bacigalupo A, Bonifazi F, et al. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2020;7:e157–e167. https://doi.org/10.1016/S2352-3026(19)30256-X . e-pub ahead of print 2020/02/01.
doi: 10.1016/S2352-3026(19)30256-X
pubmed: 32004485
Zeiser R, Polverelli N, Ram R, Hashmi SK, Chakraverty R, Middeke JM, et al. Ruxolitinib for Glucocorticoid-Refractory Chronic Graft-versus-Host Disease. N. Engl J Med. 2021;385:228–38. https://doi.org/10.1056/NEJMoa2033122 .
doi: 10.1056/NEJMoa2033122
pubmed: 34260836
Abu-Dalle I, Reljic T, Nishihori T, Antar A, Bazarbachi A, Djulbegovic B, et al. Extracorporeal photopheresis in steroid-refractory acute or chronic graft-versus-host disease: results of a systematic review of prospective studies. Biol Blood Marrow Transpl. 2014;20:1677–86. https://doi.org/10.1016/j.bbmt.2014.05.017 . e-pub ahead of print 20140524.
doi: 10.1016/j.bbmt.2014.05.017
Bojanic I, Worel N, Pacini CP, Stary G, Piekarska A, Flinn AM, et al. Extracorporeal photopheresis as an immunomodulatory treatment modality for chronic GvHD and the importance of emerging biomarkers. Front Immunol. 2023;14:1086006 https://doi.org/10.3389/fimmu.2023.1086006 . e-pub ahead of print 20230217.
doi: 10.3389/fimmu.2023.1086006
pubmed: 36875063
pmcid: 9981637
Flowers ME, Apperley JF, van Besien K, Elmaagacli A, Grigg A, Reddy V, et al. A multicenter prospective phase 2 randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease. Blood. 2008;112:2667–74. https://doi.org/10.1182/blood-2008-03-141481 . e-pub ahead of print 2008/07/16.
doi: 10.1182/blood-2008-03-141481
pubmed: 18621929
Gandelman JS, Song DJ, Chen H, Engelhardt BG, Chen YB, Clark WB, et al. A Prospective Trial of Extracorporeal Photopheresis for Chronic Graft-versus-Host Disease Reveals Significant Disease Response and No Association with Frequency of Regulatory T Cells. Biol Blood Marrow Transpl. 2018;24:2373–80. https://doi.org/10.1016/j.bbmt.2018.06.035 . e-pub ahead of print 2018/07/10.
doi: 10.1016/j.bbmt.2018.06.035
Greinix HT, Ayuk F, Zeiser R. Extracorporeal photopheresis in acute and chronic steroid‑refractory graft-versus-host disease: an evolving treatment landscape. Leukemia. 2022;36:2558–66. https://doi.org/10.1038/s41375-022-01701-2 . e-pub ahead of print 2022/09/25.
doi: 10.1038/s41375-022-01701-2
pubmed: 36153436
pmcid: 9613461
Greinix HT, van Besien K, Elmaagacli AH, Hillen U, Grigg A, Knobler R, et al. Progressive improvement in cutaneous and extracutaneous chronic graft-versus-host disease after a 24-week course of extracorporeal photopheresis-results of a crossover randomized study. Biol Blood Marrow Transpl. 2011;17:1775–82. https://doi.org/10.1016/j.bbmt.2011.05.004 . e-pub ahead of print 2011/05/31.
doi: 10.1016/j.bbmt.2011.05.004
Owsianowski M, Gollnick H, Siegert W, Schwerdtfeger R, Orfanos CE. Successful treatment of chronic graft-versus-host disease with extracorporeal photopheresis. Bone Marrow Transpl. 1994;14:845–8. e-pub ahead of print 1994/11/01;
Schoemans HM, Lee SJ, Ferrara JL, Wolff D, Levine JE, Schultz KR, et al. EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transpl. 2018;53:1401–15. https://doi.org/10.1038/s41409-018-0204-7 . e-pub ahead of print 20180605.
doi: 10.1038/s41409-018-0204-7
Fine JP, Gray RJ. J Am Stat Assoc. 1999;94:496–509.
doi: 10.1080/01621459.1999.10474144
Maas-Bauer K, Kiote-Schmidt C, Bertz H, Apostolova P, Wasch R, Ihorst G, et al. Ruxolitinib-ECP combination treatment for refractory severe chronic graft-versus-host disease. Bone Marrow Transpl. 2021;56:909–16. https://doi.org/10.1038/s41409-020-01122-8 . e-pub ahead of print 2020/11/19.
doi: 10.1038/s41409-020-01122-8