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KMID : 0366220140490020100
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Korean Journal of Hematology
2014 Volume.49 No. 2 p.100 ~ p.106
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Extracorporeal photopheresis for chronic graft-versus-host disease: a systematic review and meta-analysis
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Malik Mohsin Ilyas
Litzow Mark
William Hogan
Patnaik Mrinal
Shahrukh Hashmi
Murad Mohammad Hassan
Prokop Larry J.
Winters Jeffrey L.
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Abstract
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Background: The safety of extracorporeal photopheresis (ECP) in steroid-refractory chronic graft-ver-sus-host disease (SR-cGVHD) has been explored in multiple studies but reported re-sponse 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 or-gan-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 muscu-loskeletal 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 pop-ulations 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.
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KEYWORD
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Graft-versus-host disease, Extracorporeal photopheresis, Meta-analysis
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