Extracorporeal photopheresis reduces clinical signs of chronic graft versus host disease in pediatric patients: a case series report

Background: Graft versus Host Disease (GVHD) is a frequent pathology that affects around 60% of patients who receive allogeneic hemopoietic stem cell transplantation.The first-line treatment is corticosteroids.However, some of the patients are or become resistant to this therapy.Extracorporeal photopheresis (ECP) represents an alternative for such limitation, with no antecedents to induce resistance.The mechanisms involved in its effect are still unknown, and most of the studies developed in adults or in vitro.In the case of pediatric patients, there is few information in the literature.Clinic Case: Four pediatric patients previously diagnosed with chronic GVHD and identified as corticosteroids resistant.There were three evaluations of GVHD severity by organs and overall score before and after ECP sessions as indicates for each case.We identified T cell subpopulations using antibodies and analyzed them by flow cytometry from peripheral blood samples.There was a decrease in the severity of GVHD from the sixth session, and no preference for target tissue was observed.There was no difference between T cell subpopulations analyzed before and after ECP.Conclusion: ECP is an efficient therapy to treat chronic GVHD in pediatric patients.