| Objective:Extracorporeal photopheresis (ECP) is an immunomodulatory alternative for treatment of graft versus host disease (GVHD). Currently, the first line treatment of GVHD is cortico-steroid-based therapy. However, there are some patients who cannot benefit from it. These patients are steroid resistant, steroid denpendent or cannot tolerate the side effects of steroid. There are a large number of studies reported that ECP show a positive impact on them. Whereas, response rates and group settings are different in these studies. The therapeutic effects need to be analysed comprehensively and systematically.We conducted a meta-analysis to assess the efficacy of ECP for GVHD and systematically evaluate the response rates of ECP for different types of skin GVHD. Including ECP for GVHD (acute and chronic), the organ of skin, different grades (?/? and ?/?) skin aGVHD and different types (Sclerodermoid and lichenoid) skin cGVHD.Methods:Databases such as the PubMed/MEDLINE, EMBASE, The Cochrane Library were searched for studies concerning the response rates of ECP for aGVHD or cGVHD from inception until February,2016. Relevant references within each reviewed manuscript or review were scanned to identify other potentially relevant (and eligible) studies. Two reviewers independently screened literature according to inclusion and exclusion criteria, assessed the methodological quality using the criteria Agency for Healthcare Research and Quality (AHRQ) and extracted data from all studies using a standardized data extraction form. End points included complete response (CR), overall response (OR) and organ-specific response. Disagreements were resolved by discussion and consensus with the third author. Then, the CR rates and OR rates were pooled by adopting meta-analysis with the software of STATA 12.0, and Sensitivity analysis and Publication bias were performed.Results:22 trials with 787 patients were included. The results are shown below.1. The response rates about aGVHD and cGVHD:The pooled CR rate and OR rate for aGVHD were 57% and 79%, the pooled CR rate and OR rate for grade ?/? aGVHD were 81% and 84%, the pooled CR rate and OR rate for grade ?/? aGVHD were 44%^ 95%.The pooled CR rate and OR rate for cGVHD were 27% and 65%,the pooled OR rate for De novo was 77%,the pooled OR rate for Quiescent was 54%,the pooled OR rate for Progressive was 0.46%.2. The response rates of different organs:The pooled CR rate and OR rate for skin aGVHD were 77% and 87%,the pooled CR rate and OR rate for liver aGVHD were 57% and 77%, the pooled CR rate and OR rate for gut aGVHD were 65% and 78%.The pooled CR rate and OR rate for skin cGVHD were 39%?70%, the pooled CR rate and OR rate for liver cGVHD were 34%?0.66%, the pooled CR rate and OR rate for gut cGVHD were 67% and 73%, the pooled CR rate and OR rate for oral cGVHD were 39% and 66%.3. The response rates of different types of skin GVHD:The pooled CR rate and OR rate for grade ?/? skin aGVHD were 84% and 81%, the pooled CR rate and OR rate for grade ?/? skin aGVHD were 69% and 78%.The pooled CR rate and OR rate for lichenoid skin cGVHD were 50% and 73%, the pooled CR rate and OR rate for Scrodermoid skin cGVHD were 22% and 61%.Conclusions:1. ECP was effectiv for both aGVHD and cGVHD. It can be used as an option for refractory GVHD treatment.2. For different organs, the reaponse rates of skin aGVHD and skin cGVHD were relatively high. ECP can be considered when we face some refractory skin GVHD.3. The results shown that ECP was effective for different types skin GVHD, but there were some Limitations, for example the number of studies and patients included were small, the heterogeneity is relatively big. More high-quality, multiple-center and large-sample clicinal studies were needed to assess the real effectiveness of ECP for skin GVHD among varying types.Above all, ECP is an effective therapy for refractory GVHD, especially for the skin GVHD. |
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