SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Alloimmunity and Transplantation
This article is part of the Research TopicAllo-HSCT: novel clinical applications and therapeutic strategies in adults and analysis of rare procedure complicationsView all 4 articles
The efficacy of Extracorporeal Photopheresis in the treatment of Steroid Refractory Acute Graft-versus-Host Disease: A Systematic Review and Meta-Analysis
Provisionally accepted
Zaid Muhanna1
Ahmad Issa1
Jehad Yasin1
Leen Asharf Alkuttob1Maya Mohammad Niss1Muaath Alsufi1
Muntaser Al Zyoud1*
Shatha Farhan2- 1The University of Jordan School of Medicine, Amman, Jordan
- 2Stem Cell Transplantation and Cellular Therapy, Henry Ford Health, Detroit, Michigan, United States
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Introduction: Steroid-refractory acute graft-versus-host disease (SR-aGVHD) is a significant complication of hematopoietic stem cell transplantation (HSCT). Extracorporeal Photopheresis (ECP) represents a key second-line option. Previous reviews have provided valuable insights, and recent studies allow for an updated synthesis of efficacy, safety, and patterns of ECP use in SR-aGVHD, including outcomes not fully analysed previously. This study aims to address the literature gap by providing a comprehensive updated review of the efficacy of ECP and its patterns of use in SR-aGVHD. Materials and Methods: A Systematic literature search was conducted as per PRISMA guidelines, up to September 2024, using the PubMed, Scopus, and Cochrane databases. Studies investigating the use of ECP in the setting of chronic GVHD, GVHD prophylaxis, or first-line treatment of aGVHD were excluded. Meta-analyses using fixed and random effects models were employed to estimate the pooled effect sizes. Results: Thirty-eight studies, including a total of 1249 participants, were included, and 29 were included in the quantitative analyses. Most studies focused on the adult population, and the majority used a retrospective single-arm study design (n = 30). Overall, skin, gut, and liver response rates were 72%, 89%, 54%, and 36%, respectively. The pooled steroid-sparing percentage was 66%. ECP showed significantly higher survival in patients with grade 2 GVHD compared with grades 3 and 4 (HR: 2.35, 95% CI: 1.67 – 3.29). ECP demonstrated a positive trend in overall survival compared to other treatments, but the results were not significant. Conclusion: This review indicates that ECP is an effective treatment for SR-aGVHD, with favorable response and survival outcomes. However, due to the heterogeneity observed in the analyses among the studies, more controlled trials are needed to establish its effects in combination with other agents and against other regimens.
Keywords: Acute graft-versus-host disease (agvhd), Steroid refractory acute graft-versus-host disease, Extracorporeal photopheresis (ECP), Systematic review, Meta-analysis, Meta-regression
Received: 01 Sep 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 Muhanna, Issa, Yasin, Alkuttob, Niss, Alsufi, Al Zyoud and Farhan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Muntaser Al Zyoud, muntaserzyoud@gmail.com
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