ISSN:
1468-3083
Quelle:
Blackwell Publishing Journal Backfiles 1879-2005
Thema:
Medizin
Notizen:
Background In chronic graft-versus-host disease (cGvHD) cytotoxic and suppressor T lymphocytes probably play a decisive pathogenetic role. The efficacy of conventional immunosuppressive therapy is often insufficient, and drug side effects may produce further complications. Photochemotherapy with orally administered photosensitizer 8-methoxypsoralen (8-MOP) followed by UV-A irradiation of the skin (PUVA) has been reported as an advantage. Extracorporeal photochemotherapy (ECP) was introduced as an improved method of photochemotherapy compared with PUVA. ECP selectively affects autoreactive as well as malignant T lymphocytes and implies repeated ex vivo UV-A irradiation of chemically photosensitized leukocytes, followed by reinfusion. The treatment efficacy depends essentially on sufficient plasma levels of 8-MOP. In cases of considerable gastrointestinal malabsorption, however, therapeutic levels of 8-MOP are rarely achieved when the drug is administered orally. Objective In a case of severe cGvHD, ECP was used because of disease progression, despite massive conventional immunosuppressive therapy. Patient and method After bone marrow transplantation a 13-year-old girl developed acute GvHD, which turned later to severe cGvHD with massive involvement of the skin, oral mucosa, liver and gastrointestinal tract. The treatment with prednisolone, cyclosporin A (CsA), azathioprine and thalidomide was without success. When the patient was 15 we started ECP with individually adapted modifications. Especially because of severe gastrointestinal malabsorption, a liquid preparation of 8-MOP was administered directly into the leukocyte (buffy coat) fraction, received by leukapheresis. Results After 15 treatment cycles within 12 months immunosuppressive drugs were omitted because of noticeable improvement in cutaneous changes, liver function parameters and general condition (Karnofsky score 85–90% compared with 30–40% at the beginning). Conclusion It seems to us that this modification of ECP is a very effective and safe treatment modality for cGvHD without any side effects.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1111/j.1468-3083.1996.tb00612.x
