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Caitlin Raymond: Long-Term Infection Risk With ECP in GVHD

Caitlin Raymond/LinkedIn

Oct 10, 2026, 14:17

Caitlin Raymond: Long-Term Infection Risk With ECP in GVHD

Caitlin Raymond, a board-certified Clinical Pathologist and current Transfusion Medicine Fellow at the National Institutes of Health, shared a post on LinkedIn:

“ECP is increasingly used long term in GVHD, in part because of its excellent safety reputation.

But the only randomized trial reporting infection rates that I could find followed patients for 12 weeks. So what is the long term impact of ECP on infection risk?

Both Cochrane reviews on ECP in pediatric GVHD found zero eligible randomized trials.

The reassurance traces back to a small set of short, mostly uncontrolled series, and the only randomized trial I found reporting infection rates followed patients for 3 months.

So I used TriNetX to ask the question over a longer window.

I compared 622 propensity matched patients per arm, ECP vs. second line agents (ruxolitinib, ibrutinib, belumosudil, axatilimab), out to 24 months. What I found:

At no time point did ECP show lower infection risk.

By 24 months, ECP patients had higher rates of pneumonia (20.7 percent vs 13.5 percent), sepsis (15.0percent vs 10.3 percent), and bacteremia (10.0 percent vs 6.6 percent).

The caveats matter, and they’re in the letter: this is hypothesis generating, and it doesn’t show that ECP causes infection.

Confounding by indication is a real concern, and central line access could explain the bacteremia signal on its own.

My takeaway is that ‘no increased risk’ has never been tested over a window long enough to detect one. That question deserves prospective, long term surveillance.

Share Link with free access to the article in the comments.”

Caitlin Raymond: Long-Term Infection Risk With ECP in GVHD