Journal
BONE MARROW TRANSPLANTATION
Volume 56, Issue 4, Pages 909-916Publisher
SPRINGERNATURE
DOI: 10.1038/s41409-020-01122-8
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Funding
- Deutsche Forschungsgemeinschaft, Germany [SFB1160]
- DFG [390939984]
- GVHDCure (ERC)
- Wilhelm Sander Stiftung [2008.046.5]
- Jose-Carreras Leukemia foundation [DJCLS 01R/2019]
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The combination of Ruxolitinib and extracorporeal photopheresis has shown activity in treating glucocorticoid refractory chronic graft-versus-host disease, with a best response rate of 74%. However, some patients may experience newly diagnosed cytopenia and CMV reactivation. Further prospective trials are needed to validate the safety and efficacy of this combination therapy.
Glucocorticoid-refractory (SR) chronic (c) graft-versus-host disease (GVHD) is a multisystem immunological disease and the leading cause of non-relapse mortality (NRM) in patients surviving longer than 2 years after allogeneic hematopoietic cell transplantation. Both ruxolitinib (RUX) and extracorporeal photopheresis (ECP) have shown activity for SR-cGVHD which motivated us to treat refractory cGHVD patients with the RUX-ECP combination. In this retrospective survey, 23 patients received RUX-ECP as salvage therapy for SR-cGVHD. The best response (CR or PR) at any time point during treatment was 74% (17/23) including 9% (2/23) CR and 65% (15/23) PR. The 24-months-survival was 75% (CI 56.0-94.1). Newly diagnosed cytopenia occurred in 22% (5/23) and CMV reactivation was observed in 26% (6/23) of the patients. Serum levels of soluble interleukin-2 receptor (sIL-2R) correlated with response. Our retrospective analysis shows that the RUX-ECP combination is safe and has activity in a fraction of patients with SR-cGVHD, which needs validation in a prospective trial.
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