Figure 1
Figure 1. Relationship between BAFF and ECP treatment outcome for cGVHD. (A) Correlation between serum BAFF level after 2 paired photopheresis treatments (at 1 month of ECP) and total skin disease scores (> 0) at 3 months (r = 0.57, P = .004, Spearman rank). BAFF level showed weaker correlation with cutaneous cGVHD severity before ECP start (r = 0.24, P = .16, data not shown). (B) Serum BAFF level in the early stages of ECP treatment predicted cGVHD skin disease response. Patients grouped into serum BAFF level either less than 4 ng/mL (white bars, n = 24) or more than 4 ng/mL (gray bars, n = 11) after 2 paired treatments (1 month) of ECP had similar TSSs (median, 47 vs 48.5) before starting ECP. After 3 months of ECP, patients with early lower BAFF level demonstrated significant improvement in skin disease compared with those with higher BAFF 2 months earlier (median TSS, 4.5 vs 46, P = .002). The disparity in disease improvement between the low and high serum BAFF groups at 3 months was still evident after 6 months of ECP (median TSS, 3.5 vs 76, P = .006). (C) Lower circulating BAFF level at 1 month of ECP is associated with superior cutaneous disease outcome at 6 months (P < .01). Combined response rate (CR + PR, dark and light gray bars) for low BAFF level patients (< 4 ng/mL) was also higher in lung, mucous membrane, and ocular GVHD, but individual organ response rates were not significantly different for these less common manifestations (P > .05). Patients who achieved full or partial cutaneous response at 6 months of ECP did exhibit contrasting rates of extracutaneous organ response at the same time point (65% and 50%, respectively) compared with cutaneous nonresponders (35%, P = .06, not significant, Fisher exact). (D) Serum BAFF level after 3 months of ECP predicted durability of skin disease response at 6 months. Four of 13 patients (31%) with BAFF level greater than 4 ng/mL at 3 months saw further improvement or maintenance of initial response (white bars), whereas remaining patients (69%) saw deterioration in skin disease (gray bars). In contrast, 12 of 15 (80%) patients with BAFF less than 4 ng/mL at 3-month ECP had durable responses, either maintaining full skin disease resolution or continuing improvement at 6 months (P = .02, Fisher exact). Patients with high BAFF after 3 months of ECP had lower 6-month extracutaneous organ response rate than low BAFF patients (42% vs 54%; data not shown, P = .2, not significant).

Relationship between BAFF and ECP treatment outcome for cGVHD. (A) Correlation between serum BAFF level after 2 paired photopheresis treatments (at 1 month of ECP) and total skin disease scores (> 0) at 3 months (r = 0.57, P = .004, Spearman rank). BAFF level showed weaker correlation with cutaneous cGVHD severity before ECP start (r = 0.24, P = .16, data not shown). (B) Serum BAFF level in the early stages of ECP treatment predicted cGVHD skin disease response. Patients grouped into serum BAFF level either less than 4 ng/mL (white bars, n = 24) or more than 4 ng/mL (gray bars, n = 11) after 2 paired treatments (1 month) of ECP had similar TSSs (median, 47 vs 48.5) before starting ECP. After 3 months of ECP, patients with early lower BAFF level demonstrated significant improvement in skin disease compared with those with higher BAFF 2 months earlier (median TSS, 4.5 vs 46, P = .002). The disparity in disease improvement between the low and high serum BAFF groups at 3 months was still evident after 6 months of ECP (median TSS, 3.5 vs 76, P = .006). (C) Lower circulating BAFF level at 1 month of ECP is associated with superior cutaneous disease outcome at 6 months (P < .01). Combined response rate (CR + PR, dark and light gray bars) for low BAFF level patients (< 4 ng/mL) was also higher in lung, mucous membrane, and ocular GVHD, but individual organ response rates were not significantly different for these less common manifestations (P > .05). Patients who achieved full or partial cutaneous response at 6 months of ECP did exhibit contrasting rates of extracutaneous organ response at the same time point (65% and 50%, respectively) compared with cutaneous nonresponders (35%, P = .06, not significant, Fisher exact). (D) Serum BAFF level after 3 months of ECP predicted durability of skin disease response at 6 months. Four of 13 patients (31%) with BAFF level greater than 4 ng/mL at 3 months saw further improvement or maintenance of initial response (white bars), whereas remaining patients (69%) saw deterioration in skin disease (gray bars). In contrast, 12 of 15 (80%) patients with BAFF less than 4 ng/mL at 3-month ECP had durable responses, either maintaining full skin disease resolution or continuing improvement at 6 months (P = .02, Fisher exact). Patients with high BAFF after 3 months of ECP had lower 6-month extracutaneous organ response rate than low BAFF patients (42% vs 54%; data not shown, P = .2, not significant).

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