Effect Of Plasma Exchange On Acute Graft Versus Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

[Objective]Acute graft versus host disease (aGVHD) is one of the major complications afterallogeneic hematopoietic stem cell transplantation (allo-HSCT) with high mobidity and mortality, myeloablative treatment and the application of immuno-suppressive drugs (such as CsA, FK506, MMF, et al) are the main method of prevention and cure. As it can separate pathogen, toxin, antigen and antibody from the plasma , plasma exchange (PE) is used to prevent and treat autoimmune disease, the rejection of stereo-organ transplantation, acute intoxication, severe hepatitis, acute hepatic failure, et al , but is rarely used to aGVHD. This text is to investigate weather PE is an effective method in the therapy of aGVHD after allo-HSCT, and the possible mechanisms it does.[Methods]From October 2001 to March 2004, eight patients received PE due to aGVHD after Allo-HSCT with little response of immuno-suppressive drugs or relapse when the dose of immuno-suppressive drugs decreased. Four of them are CML, the others are M2a> M4> M5 and M6. After transplantation, all of them got II-IV aGVHD, the effectiveness was observed, and the level of tumor necrosis factor- a (TNF- a ) in the serum of the patients before/after plasma exchange was also measured.[Results]The overall response rate is pleasurable, with 3 cases (37.5%) having overt response , which was especially seen in patients with intestinal tract symptoms, and the level of TNF- a in the serum of the patients after plasma exchange was more lower than that of the patients before plasma exchange(P=0.018).[Conclusion]PE is a effective therapeutic method to control the symptoms (especially the intestinal tract symptoms) of aGVHD after allo-HSCT with little response of immuno-suppressive drugs or relapse when the dose of immuno-suppressive drugs decreased. It is likely to due to the decrease of cytokines, especially the level of TNF- a in serum after PE.