Cryopreservation As an Alternative Approach for Applying Photopheresis Products to Treat Graft-Versus-Host Disease (Gvhd) Among Pediatric Patients in Developing Countries Publisher Pubmed



Jafari L ; Ashkevari P ; Ansari S ; Delkhah M ; Karamlou Y ; Asephi N ; Kashani H ; Mohseni R ; Farajifard H ; Salmanifard MT ; Jafari F ; Behfar M ; Hamidieh AA
Source: Pediatric Transplantation Published:2025

Abstract

Background: A significant challenge in extracorporeal photopheresis (ECP) in developing countries is the high cost of apheresis equipment. Additionally, obtaining proper IV access in pediatric patients is considerably more difficult than in adult patients. To address the limitations of applying ECP for pediatric patients, such as vein access difficulties, time constraints, and costs, the cryopreservation of mononuclear cells (MNCs) has been explored. Since cryopreservation reduces the need for repeated apheresis procedures, it offers potential convenience for pediatric patients and resource-limited settings, particularly in developing countries. Study Design and Methods: Twenty-four pediatric patients with steroid-resistant or steroid-dependent acute or chronic GvHD participated in this study. All patients underwent offline apheresis. The viability and proliferation rates of fresh and thawed MNCs were assessed using flow cytometry and the CFSE assay. The clinical response was also evaluated at various time points over 21 months for all patients. Results: There were no significant differences in annexin/PI analysis (p = 0.39) and CFSE assay (p = 0.8) between fresh and thawed samples using flow cytometry. Response to ECP after nine months in aGvHD revealed favorable results, with a complete response in 12 patients (60%) and a partial response in 8 patients (40%), which remained stable until 12 months after ECP therapy. In cGvHD, complete and partial responses were the same and occurred in 7 patients (46.6%). Conclusion: Cryopreserving MNCs for ECP in pediatric patients with steroid-resistant GvHD is a practical and effective method to overcome existing limitations. We propose that cryopreservation could be a more effective option than repeated apheresis for pediatric patients and in developing countries, as it reduces costs and eliminates the need for multiple apheresis sessions. © 2025 Elsevier B.V., All rights reserved.