Extracorporeal Photochemotherapy after Cardiac Transplantation: A New Therapeutic Approach to Allograft Rejection

Dall’Amico, Roberto; Montini, Giovanni; Murer, Luisa; Andreetta, Barbara; Zacchello, Graziella; Gambino, Antonio; Feltrin, Giuseppe; Caforio, Alida L.P.; Tursi, V.; Livi, Ugolino

doi:10.1177/039139880002300108

Cited by 32 publications

(25 citation statements)

References 22 publications

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“…[4][5][6][7] Extracorporeal photopheresis (ECP) has been shown to be efficacious in the treatment of cutaneous T-cell lymphoma (CTCL), selected autoimmune disorders and solid organ allograft rejection. [8][9][10][11][12][13][14][15][16][17][18] While the mechanism of action of ECP in autoimmune disorders is still not fully defined, it is believed that in CTCL patients, the combination of ultraviolet light and 8-methoxypsoralen induces apoptosis in a small subset of circulating clonal tumor or autoreactive T-lymphocytes, resulting in the stimulation of a cytotoxic T-cell response against the clone. 19,20 A number of retrospective reports have demonstrated efficacy of ECP therapy in patients with skin and visceral manifestations of cGVHD, but little information is available regarding prognostic or biological variables predictive of response.…”

mentioning

confidence: 99%

Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors

Foss

DiVenuti

Chin

et al. 2005

Bone Marrow Transplant

168

140

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Summary:We enrolled 25 patients with extensive, steroid-refractory chronic graft-versus-host disease (cGVHD) in a prospective trial evaluating the efficacy of extracorporeal photophoresis (ECP) in both skin and visceral cGVHD. The median time from transplant to initiation of ECP was 790 days. ECP was administered for 2 consecutive days every 2 weeks in 17 patients and once a week in eight patients until best response or stable disease. The median duration of therapy was 9 months (range 3-24 months). In all, 20 patients had improvement in cutaneous GVHD and six had healing of oral ulcerations. Steroid sparing or discontinuation of immunosuppressive medications was possible in 80% of patients. Response rates were similar between patients receiving treatment weekly vs every 2 weeks and in patients commencing ECP less than vs greater than 18 months from transplant (70 vs 66%). When patients were stratified based on the Akpek prognostic score, there was no difference in overall response between the favorable (Akpek scoreo2.5) and unfavorable risk groups, but patients with progressive onset cGVHD tended to have a higher response than those with de novo onset. In summary, we report improvement in skin and/or visceral cGVHD in 71% overall and 61% of high-risk patients.

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mentioning

confidence: 99%

Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors

Foss

DiVenuti

Chin

et al. 2005

Bone Marrow Transplant

168

140

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“…В ре-зультате у реципиентов значительно снизились час-тота и тяжесть эпизодов, что было подтверждено ежемесячными эндомиокардиальными биопсиями. Также применение ЭФХТ позволило значительно и безопасно снизить дозировки циклоспорина А, преднизолона и азатиоприна [5].…”

Section: экстракорпоральная фотохимиотерапия при трансплантации солидunclassified

“…et al, 1999 [16] 1992-1999 8 легкое Villanueva J. et al, 2000 [17] 1999-2000 14 легкое Lucid C.E. et al, 2011 [4] 2008-2009 9 легкое Dall'Amico R. et al, 2000 [5] 1995-2000 11 сердце Giunti G., 1999 [18] 1996-1998 6 сердце Maccherini M., 2001 [19] 1996 [12] 1999-2008 10 почка Lai Q., 2012 [13] 2006-2009 6 почка тоидные») -Tх 2 ответ. Существует гипотеза, соглас-но которой ДК 2-го типа могут быть ответственны-ми за поддержание периферической Т-клеточной толерантности к аутоантигенам, в то время как ДК 1-го типа -за антиген-специфичный Т-клеточный ответ.…”

Section: механизм действия фотофорезаunclassified

Some of the Mechanisms of Extracorporeal Photochemotherapy in Solid Organ Transplantation

Vatazin¹,

Зулькарнаев²,

Кильдюшевский³

et al. 2014

Russian Journal of Transplantology and Artificial Organs

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ВВЕДЕНИЕЕжегодно в России, как и во всем мире, отме-чается увеличение числа больных с терминальной стадией хронической болезни почек. При этом наиболее оптимальным методом заместительной почечной терапии и, по сути, единственным ради-кальным способом лечения является аллотранс-плантация трупной почки (АТП).Своеобразной «чашей Грааля» в транспланто-логии является достижение иммунологической толерантности к аллоантигенам трансплантата. На протяжении второй половины ХХ века были достигнуты значительные успехи, что позволило значительно увеличить выживаемость трансплан-татов. Однако, к сожалению, не смотря на это, современные иммуносупрессивные препараты, по-давляя иммунный ответ, не способны к индукции толерантности по отношению к трансплантату. Бо-ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская Федерация Снижение риска развития отторжения почечного трансплантата -перспективное направление современ-ной медицинской науки. Одним из перспективных методов снижения активности иммунологического конфликта между реципиентом и донорским органом и достижения частичной иммунологической толе-рантности является фотохимиотерапия. Этот метод широко применяется за рубежом при трансплантации сердца и легких. Отечественный опыт применения этого метода у реципиентов почечного транспланта-та крайне мал. В настоящем обзоре литературы представлено современное представление о механизме действия этого метода.Ключевые слова: фотохимиотерапия, трансплантация почки. SOME OF THE MECHANISMS OF EXTRACORPOREAL PHOTOCHEMOTHERAPY IN SOLID ORGAN TRANSPLANTATION Vatazin A.V., Zul'karnaev A.B., Kil'djushevskij A.V., Fedulkina V.A., Krstic M. Postgraduate Medical M.F. Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russian FederationReducing the risk of kidney transplant rejection is a perspective trend in modern medical science. One of the promising methods for reducing the activity of immune confl ict between the recipient and the donor organ and the achievement of partial immunological tolerance is photochemotherapy. This method is widely used in overseas heart and lung Transplantation. Domestic experience of applying this method in renal transplant recipients is extremely small. In this review of literature a modern representation of the scientists on the mechanism of action of this method is presented. Key words: photochemotherapy, kidney transplantation.лее того, иммуносупрессивная терапия вследствие своей недостаточной селективности может спо-собствовать ингибированию естественных регуля-торных механизмов развития иммунологической толерантности к донорским антигенам, а также ес-тественных факторов иммуносупрессии. Помимо этого, современные иммуносупрессивные препара-ты имеют множество осложнений, повышают риск развития инфекционных и онкологических ослож-нений.В связи с этим разработка новых методов ле-чения, способствующих снижению активности иммунологического конфликта путем индукции иммунологической толерантности без повышения медикаментозной иммунос...

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“…Early, small pilot studies in patients with cardiac transplant rejection indicated that ECP in addition to conventional immunosuppressive treatment could reduce or reverse rejection and reduce the incidence of rejection episodes [37,38]. Subsequently, larger studies followed to investigate the prophylactic use of ECP in this setting [39].…”

Section: Solid Organ Transplant Rejectionmentioning

confidence: 99%

Clinical Results of Extracorporeal Photopheresis

Worel

Leitner²

2012

Transfus Med Hemother

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Extracorporeal photopheresis (ECP) is a combination of leukapheresis and photodynamic therapy in which blood is treated with photoactivable drugs which are then activated with ultraviolet light and re-infused to the patient. It has been used successfully for more than 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (GVHD). ECP has also shown promising results in the treatment of acute GVHD and other T-cellmediated diseases, including systemic sclerosis, treatment and prevention of solid organ rejection, and more recently Crohn’s disease. The use of ECP may allow a significant reduction or even discontinuation of corticosteroids and/or other immunosuppressants, thus leading to reduced long-term morbidity and mortality and improved overall survival. ECP is a well-tolerated therapy. No significant side effects have been reported during the last 30 years. It has been shown that ECP is not associated with an increased incidence of infections, malignancies, or recurrence of underlying malignant disease, neither during short-term nor during long-term therapy.

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Extracorporeal Photochemotherapy after Cardiac Transplantation: A New Therapeutic Approach to Allograft Rejection

Abstract: ECP is a well tolerated treatment. Its administration allows better RR control and significant reduction in immunosuppressive therapy.

Cited by 32 publications

References 22 publications

Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors

Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: analysis of response and survival incorporating prognostic factors

Some of the Mechanisms of Extracorporeal Photochemotherapy in Solid Organ Transplantation

Clinical Results of Extracorporeal Photopheresis

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