Clinical evidence for extracorporeal photopheresis in the treatment of chronic graft-versus-host disease

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  • 体外フォトフェレーシス（extracorporeal photopheresis）による慢性移植片対宿主病の治療エビデンス

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<p> Extracorporeal photopheresis (ECP) was approved in Japan for steroid-refractory, or-intolerant chronic graft-versus-host disease (cGVHD) in December 2020. The mechanism of action of ECP is still not completely understood, however, it has been hypothesized that the immunomodulation induced by ECP, including induction of lymphocyte apoptosis, shift in antigen-presenting cell populations, shift in cytokine secretion, induction of regulatory T cells, increase in myeloid-derived suppressor cells, and alteration of B-cell signaling and populations are responsible for the therapeutic effect of ECP on cGVHD. There is a wealth of clinical evidence for ECP from clinical studies conducted mainly in Europe and America, and this evidence generally supports the efficacy and safety of ECP in the treatment of cGVHD. The improved response rate by ECP therapy has been observed in various organs and, in particular, higher response rates have been reported for skin, oral mucosa and liver. The reduction in the dose of concomitantly administered steroids and prolongation of overall survival have also been observed in cGVHD patients treated with ECP. ECP therapy has been generally reported to be tolerable with an acceptable safety profile. It is important to accumulate additional clinical evidence for ECP therapy in Japanese cGVHD patients in real-world clinical practice.</p>

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