Treatment of graft versus host disease (GVHD) by photopheresis?

Graft versus host disease (GVHD), whether acute or chronic, is a frightening complication of bone marrow allografts - indeed in many cases it can be life threatening. In chronic GVHD, the symptoms are less serious, but they can nevertheless be alarming. The mechanism of this reaction is very complex and the pathogenesis of chronic GVHD seems to be slightly different from that of acute GVHD. However, there is no doubt about the immune mechanisms. The production of numerous cytokines plays an important part and has also been des-cribed. Until the use of photopheresis, the only treatments that were effective to any degree have been immunosuppressive treatments. Extracorporeal photopheresis (ECP), a technique recently proposed in chronic GVHD, is promising and is believed to attack the actual cause of the disease (the role of cytotoxic T lymphocytes is now recognized). ECP is believed to have a complex mechanism of action; the explanation of an anti-TT lymphocyte action of ECP seems too simple. We report the results of three patients suffering from chronic GVHD, refractory to the usual treatments. The schedule for ECP was a cycle of two treatments every 2 weeks. We recorded a complete remission for patient No. I (grade 1) with no relapse for now 3 years. In patient No. 2 (grade 2-3) a progressive improvement was observed in the various symptoms with, however, several episodes of aggravation. In patient No. 3 (grade 2-3), the skin symptoms improved and the lichen planus lesions healed after only 15 months of treatment (interrupted by two infectious episodes during which ECP was stopped). Although the study population was small, we may be justified in thinking that ECP can cause an improvement in chronic GVHD refractory to immunosuppressive treatment. These results should be confirmed by a rigorously designed multicentre study. (C) 1997 Elsevier Science Ltd.