Extracorporal Photopheresis Pilot Study (ECP)

• Efficacy: decrease in incidence of acute GVHD and chronic GVHD [ Time Frame: during 2 years ] [ Designated as safety issue: No ]
• Incidence of Infection (clinically et/or bacteriologically proved) [ Time Frame: during 2 years ] [ Designated as safety issue: Yes ]
• Documentation of chimerism [quantification of donor-type chimerism in bone marrow and/ or in peripheral blood (total blood, CD3+)] [ Time Frame: during 2 years ] [ Designated as safety issue: No ]
• Transplant-related Mortality [ Time Frame: at 3 months and 1 year ] [ Designated as safety issue: No ]
  TRM at 3 months for acute GVHD and at 1 year for chronic GVHD
• Toxicity at Day 180 after HSC transplantation [ Time Frame: Day 180 ] [ Designated as safety issue: Yes ]
• Disease-free survival (DFS) [ Time Frame: at 1 and 2 years ] [ Designated as safety issue: No ]
• progression-free survival (PFS) [ Time Frame: at 1 and 2 years ] [ Designated as safety issue: No ]
• Overall survival (OS) [ Time Frame: at 1 and 2 years ] [ Designated as safety issue: No ]
• cumulative incidence of relapse [ Time Frame: at 1 and 2 years ] [ Designated as safety issue: No ]

• Efficacy: decrease in incidence of acute GVHD and chronic GVHD [ Time Frame: during 2 years ] [ Designated as safety issue: No ]
• Incidence of Infection (clinically et/or bacteriologically proved) [ Time Frame: during 2 years ] [ Designated as safety issue: Yes ]
• Documentation of chimerism [quantification of donor-type chimerism in bone marrow and/ or in peripheral blood (total blood, CD3+)] [ Time Frame: during 2 years ] [ Designated as safety issue: No ]
• Disease-free survival (DFS), progression-free survival (PFS), Overall survival (OS), cumulative incidence of relapse, and evaluation of Transplant-related Mortality (TRM at 3 months for acute GVHD and at 1 year for chronic GVHD) [ Time Frame: at 1 and 2 years ] [ Designated as safety issue: No ]
• Toxicity at Day 180 after HSC transplantation [ Time Frame: Day 180 ] [ Designated as safety issue: Yes ]

ECP will be given to the patients [UVAR®XTS TM Therakos system, Johnson & Johnson] according to the following schedule:

Starting at day 21 after transplant, if hematologic recovery allowed it: 2 ECP per week the first 2 weeks, and 1 ECP per week during 1 month.

Total = 8 ECP after transplantation.

• Drug: methoxsalen

  UVADEX® is supplied in a 10 mL single-use vial. Each mL of solution contains 20 mcg of UVADEX®.

  In the ECP process, UVADEX® will be injected directly into the Recirculation Bag of the extracorporal circuit after completion of the buffy coat collection, just prior to pressing the photoactivation button. The dose of UVADEX used to inoculate these cells will be calculated based on the treatment volume collected during the plasma/buffy coat collection process, usinge the following formula :

  Treatment Volume in mL x 0.017 = Dose of UVADEX® (in mLs) required for administration into the recirculation bag.

  After the cells are inoculated with UVADEX, the buffy coat/plasma suspension is irradiated with ultraviolet-A light and then reinfused back into the patient.

  Other Name: UVADEX®
• Procedure: Extracoporal Photopheresis (ECP)

  In the ECP process, UVADEX® will be injected directly into the Recirculation Bag of the extracorporeal circuit after completion of the buffy coat collection, just prior to pressing the photoactivation button.

  After the cells are inoculated with UVADEX, the buffy coat/plasma suspension is irradiated with ultraviolet-A light and then reinfused back into the patient.

  Other Name: ECP kits : UVAR®XTS™

Inclusion Criteria:

• Patients ≥ 18 years and < or = 65 years with an hematological malignancy indicated for an allogeneic transplantation after reduced intensity conditioning :
• due to the age : for patients between 55 and 65 years.
• or for patients between 18 and 55 years of age presenting a risk of increased toxicity for myeloablative conditioning (cardiac, renal or pulmonary pathology)
• CML and MPS in blastic phase achieving CR,
• MM stage II or III, relapse after autologous transplant, achieving a response ≥ 30% or on first line if high risk,
• NHL in 2nd CR, PR after chemotherapy or autologous transplant, chemo-sensible.
• CLL in 2nd CR, PR after chemotherapy or autologous transplant, chemo-sensible.
• AML in 2nd CR or in first line for high risk criteria, secondary AML. In AML, high risk criteria are defined by : LAM 7, leukocytes>30000/mm3, cytogenetic abnormalities: t(6,9); 11q23, 17p, 11q, 20q, 21q, -5, del(5q), -7/del7q, del 9q and inv 3q,
• ALL in 2nd CR or in first line for high risk criteria defined by cytogenetic abnormalities: 11q23, t(9,22); t(1,19); t(4,11).
• MDS patients without prior chemotherapy
• HLA identical sibling donor
• Performans status < or = 2
• Patients member of a social security company

Exclusion Criteria:

• Age < 18 years or > 65 years
• Pregnant or lactating females
• Known HIV positivity
• Active infectious hepatitis, type A, B or C
• Performance status > 2 according to WHO
• Left ventricular ejection fraction < 40% and Alveolus-capillary diffusion < 50%
• Uncontrollable hypertension with medical therapy
• Creatinine clearance < 60 ml/min
• Hypersensitivity or allergy to psoralen (methoxsalen)
• Disease associated with a photosensitivity
• Hypersensitivity or allergy to both heparin and citrate products
• Contra-indication to Busulfan, Fludarabine, SAT or methotrexate
• Hypersensitivity to ciclosporine, mycophenolate mofetil or mycophenolic acid