Extracorporeal Photopheresis in Patients with Acute Graft-Versus-Host Disease

Graft-versus-host disease (GvHD) is the leading cause of mortality and morbidity following allogeneic stem cell transplantation. Steroids are currently used as first-line treatments for acute and chronic GvHD (aGvHD and cGvHD, respectively). However, the prognosis of steroid-refractory GvHD is poor, and no standard second-line treatments are available for these patients. As a result, efforts to develop novel treatment approaches continue. Extracorporeal photopheresis (ECP), a leukapheresis-based procedure for the treatment of aGvHD and cGvHD, has become a significant alternative for treating steroid-refractory aGvHD because it does not induce systemic immunosuppression, and it has demonstrated significant efficacy and an excellent safety profile. However, when used alone, it is not superior to other treatment options. In randomized studies, ruxolitinib, a selective Janus kinase (JAK) 1/2 inhibitor, has shown high response rates for both aGvHD and cGvHD. The combination of ruxolitinib and ECP may improve outcomes in cases of steroid-refractory GvHD. Nevertheless, further experimental and randomized controlled studies are needed to determine the optimal patient selection criteria and treatment regimens for aGvHD.