Extracorporeal Photopheresis of Cutaneous T-Cell Lymphoma Is Associated with Reduction of Peripheral CD4+ T Lymphocytes

Abstract

Background: Extracorporeal photopheresis (ECP) has been successfully introduced for the treatment of cutaneous T-cell lymphoma; however, the mechanism(s) of its action is (are) unknown. Objective: To investigate the effects of ECP on the immune system of patients with cutaneous T-cell lymphoma. Methods: Clinical response and changes of lymphocyte subpopulations in 20 patients with cutaneous T-cell lymphoma under ECP monotherapy or combined regimens were evaluated and compared after 3, 6 and 12 ECP cycles. Results: Thirteen of 20 patients showed a ≥50% reduction of skin lesions after 6–12 ECP cycles. An overall T-lymphocyte reduction was assessed with a balanced CD4+ T-helper and CD8+ T-suppressor cell decrease in responders. In contrast, there was a trend of CD4+ T-helper cell increase in nonresponders which could result from the failure of treatment to control the natural course of the disease. The CD4+/CD8+ ratios were 1.6 at baseline and 1.4 after 12 cycles in responders, while they increased from 1.7 to 4.1 in nonresponders, respectively (p = 0.047). In addition, there was an overall decrease in the CD57+/CD8+ T-cell subpopulation mostly due to a reduction in the responder group. Conclusion: The marked differences detected in certain T-cell subpopulations suggest an effect of ECP on peripheral T lymphocytes and, especially, on CD4+ cells.

Extracorporeal photopheresis in chronic graft-versus-host disease

“…Normalization of CD4/CD8 ratios has been described in CTCL patients, 34 as well as a shift from predominantly Th2 to Th1 cytokine secretion. In the context of CTCL, the restoration of Th1 cytokine secretion increases IL-12 production by monocytes, which might subsequently inhibit Th2 cytokine secreting cells that are believed to be responsible for the clinical manifestations of CTCL.…”

The Immunological Effect of Photopheresis in Children with Newly Diagnosed Type 1 Diabetes

“…It has been claimed that photopheresis has immunemodulating effects (12) and is a treatment of great interest for several immunological diseases including cutaneous T-cell lymphoma (13,14), acute and chronic graft versus host disease (15), cardiac allografts rejection (16), rheumatoid arthritis (RA) (17), systemic lupus erythematosus (SLE) (18) and psoriatic arthritis (19). However, the mechanisms of action are not well understood.…”

Short-Time Extracorporeal Photochemotherapy in the Treatment of Drug-Resistant Autoimmune Bullous Diseases

“…Nevertheless, ECP should be used with caution, since it has profound immunomodulatory activities on the T-cell system [7, 8, 9, 10]. Due to its effectiveness and risk-benefit ratio as well as the cost-benefit ratio, short-time adjuvant ECP is a recommendable treatment modality for drug-resistant autoimmune bullous disease.…”

“…photopheresis; ECP) combines intermittend leukapheresis and extracorporeal photochemotherapy with a photosensitizer (usually 8-methoxypsoralen, 8-MOP) [6]. It has been shown to induce apoptosis and immune response against aberrant T-cell clones and to decrease peripheral CD4+ T-lymphocyte counts [6, 7, 8, 9, 10]. Today, ECP is considered as one of the standard treatments for cutaneous T-cell lymphoma in the USA and several European countries [11].…”