Abstract
As the use of hematopoietic stem cell transplantation (HSCT) has become a more widespread and effective treatment for hematological malignant and non-malignant conditions, the need to minimize the harmful effects of graft- vs.-host disease (GvHD) has become more important in achieving good outcomes. With diagnosis of GvHD reliant on its clinical manifestations, research into biomarkers for the diagnosis, progression, and even for the prediction of disease, is imperative to combating the high levels of morbidity and mortality post-HSCT. Despite the development of novel treatment approaches to GvHD, corticosteroids remain the standard first-line treatment, with immunosuppressant therapies as second-line options. These strategies however have significant limitations and associated complications. Extracorporeal Photopheresis (ECP) has shown to be effective and safe in treating patients with symptomatic GvHD. ECP has been shown to have varied effects on multiple parts of the immune system and does not appear to increase the risk of relapse or infection in the post HSCT setting. Even so, ECP can be logistically more complex to organize and requires patients to be sufficiently stable. This review aims to summarize the potential role of biomarkers to help guide individualized treatment decisions in patients with acute and chronic GvHD. In relation to ECP, robust biomarkers of GvHD will be highly useful in informing patient selection, intensity and duration of the ECP schedule, monitoring of response and other treatment decisions alongside the concurrent administration of other GvHD therapies. Further research is warranted to establish how GvHD biomarkers are best incorporated into ECP treatment pathways with the goal of tailoring ECP to the needs of individual patients and maximizing benefit.
Highlights
Hematopoietic stem cell transplantation (HSCT) has become an established routine treatment for hematological malignancies, with over a million transplants having taken place across five continents [1]
A major limiting factor of this curative treatment is the development of graft vs. host disease (GvHD), which is a key cause of morbidity and mortality to patients following
This study demonstrated the change in immune populations to be indicative of better response to Extracorporeal Photopheresis (ECP), in the first 3 months of treatment and irrespective of GvHD type
Summary
Hematopoietic stem cell transplantation (HSCT) has become an established routine treatment for hematological malignancies, with over a million transplants having taken place across five continents [1]. A major limiting factor of this curative treatment is the development of graft vs host disease (GvHD), which is a key cause of morbidity and mortality to patients following. ECP and Novel Biomarkers in Optimizing Management of GvHD allogeneic HSCT [2], where control of GvHD is central to optimizing long-term outcomes. The therapeutic action of HSCT relies on the graft vs leukemia (GvL) effect, which makes systemic immunosuppression for GvHD prevention and treatment undesirable [3]. Effective prevention and treatment of GvHD is a challenging balance between targeting GvHD whilst maintaining the GvL effect. Increased understanding of the pathophysiology of GVHD has driven strategies to enable earlier diagnosis, alter management and apply new therapeutic interventions [4].
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