OBJECTIVES: Chronic Graft-Versus-Host Disease (cGVHD) is an important cause of death after allogeneic hematopoietic stem cell transplantation (HSCT). The objective of this study was to conduct a systematic review and meta-analysis to assess the efficacy and safety of extracorporeal photopheresis (ECP) for steroid-refractory, -intolerant or -dependent cGVHD patients after allogeneic HSCT.

METHODS: A systematic review was performed according to ISPOR recommendations (PROSPERO CRD42020203263). The searches were conducted in MEDLINE/PubMed and Scopus databases. Longitudinal studies evaluating ECP for cGVHD after corticosteroid (CTC) failure were considered. Proportion non-comparative meta-analyses were conducted using ‘R’ and the ‘meta’ package. Inverse of variance method and random effects model were used. Heterogeneity was estimated using I². ‘Response’ refers to complete or partial response to treatment.

RESULTS: The initial search retrieved 1,466 papers. After screening, 35 studies were included in the systematic review; 30 were classified as observational studies, 4 as interventional and 1 was a randomized controlled trial. Meta-analyses were conducted for response outcomes: a) overall: 65%, 95% CI 59-71%, I² 42%; b) skin: 62%, 95% CI 52-72%, I² 79%; c) liver: 55%, 95% CI 41-69%, I² 53%; d) gastrointestinal: 57%, 95% CI 40-72%, I² 9%; e) joint: 39%, 95% CI 21-60%, I² 36%; f) mucosa: 69%, 95% CI 53-81%, I² 66%; g) eye: 55%, 95% CI 42-68%, I² 56%; h) lung: 30%, 95% CI 19-44%, I² 9%; and also for the outcomes i) CTC discontinuation: 37%, 95% CI 25-51%, I² 65%; j) ≤50% CTC dose reduction: 48%, 95% CI 37-60%, I² 74%, k) any CTC dose reduction: 85%, 95% CI 80-89%, I² 0%. It was not possible to conduct meta-analyses for other outcomes. Sensitivity analyses, including the removal of interventional studies from meta-analysis, did not affect the results.

CONCLUSIONS: The meta-analysis showed that ECP is effective and enables CTC sparing effect.