Therapeutic options are limited for patients developing refractory sclerotic-type chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation. We previously showed that imatinib mesylate (IM) could be efficacious in this situation, although complete responses were uncommon (Magro L Blood 2009). We hypothesized that the combination of extracorporeal photopheresis (ECP) and IM could have synergistic effects to treat SR steroid-refractory cGVHD. While IM and ECP are separately used for the treatment of refractory cGVHD, the combination of both has never been investigated. We describe here the efficacy of the concurrent administration of IM with ECP in seven patients with refractory sclerotic-type cGVHD who had showed insufficient response to either IM or ECP. Seven consecutive patients (3 males and 4 females) with a median age of 46 years old, who received imatinib with concurrent ECP for refractory sclerotic-type cGVHD, were included. Patients were considered refractory if they were steroid-refractory or steroid-dependent. Four patients had previously showed insufficient partial response (PR) to IM, while three patients showed insufficient PR while receiving ECP. IM was started at 200 mg/day and increased to 400 mg/day if well-tolerated. ECP was initiated twice weekly then less frequently according to the patient's individual treatment response. With a median follow-up of 56 months, the concurrent administration of IM with ECP deepened responses in all patients and induced durable complete responses (CR) in 4 (57%). Median time to best response was 4 months. Median duration of combination treatment was 42 months (range: 4-60). As of February 2018, 5 patients were still alive. Two patients died of myocardial infarction and one from relapse of a preexisting prostate cancer. The concurrent administration of IM with ECP led to complete and sustained responses in patients with refractory sclerotic-type cGVHD.
Keywords: Extracorporeal; Graft-versus-host disease; Hematopoietic cell transplantation; Imatinib; Photopheresis.
Copyright © 2019 Elsevier Masson SAS. All rights reserved.