Extracorporeal photopheresis: what is it and when should it be used?

Abstract

Extracorporeal photopheresis (ECP) is a technique that was developed > 20 years ago to treat erythrodermic cutaneous T-cell lymphoma (CTCL). The technique involves removal of peripheral blood, separation of the buffy coat, and photoactivation with a photosensitizer and ultraviolet A irradiation before re-infusion of cells. More than 1000 patients with CTCL have been treated with ECP, with response rates of 31-100%. ECP has been used in a number of other conditions, most widely in the treatment of chronic graft-versus-host disease (cGvHD) with response rates of 29-100%. ECP has also been used in several other autoimmune diseases including acute GVHD, solid organ transplant rejection and Crohn's disease, with some success. ECP is a relatively safe procedure, and side-effects are typically mild and transient. Severe reactions including vasovagal syncope or infections are uncommon. This is very valuable in conditions for which alternative treatments are highly toxic. The mechanism of action of ECP remains elusive. ECP produces a number of immunological changes and in some patients produces immune homeostasis with resultant clinical improvement. ECP is available in seven centres in the UK. Experts from all these centres formed an Expert Photopheresis Group and published the UK consensus statement for ECP in 2008. All centres consider patients with erythrodermic CTCL and steroid-refractory cGvHD for treatment. The National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and suggested a need for expansion while recommending its use in specialist centres. ECP is safe, effective, and improves quality of life in erythrodermic CTCL and cGvHD, and should be more widely available for these patients.

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

“…5,6,14,17,[34][35][36][37] Our studies demonstrate that ECP treatment rapidly augments PMN-MDSCs, which dampen Th1 and Th17 T-cell responses. Therefore, these studies suggest that, in addition to inducing lymphocyte apoptosis and modulating adaptive immunity, ECP acts on the innate arm of the immune system by rapidly inducing a neutrophilic immunomodulatory MDSC population.…”

Some of the Mechanisms of Extracorporeal Photochemotherapy in Solid Organ Transplantation

“…Это выгодно отличает ЭФХТ от традиционной медикаментозной иммуно-супрессии. Осложнения, развитие которых возмож-но при применении ЭФХТ, -головная боль, повы-шение температуры тела (обычно через 4-12 часов после реинфузии обработанной клеточной суспен-зии), тошнота (чаще развивается при использова-нии пероральных препаратов 8-метоксипсоралена), гипотензия, вазовагальный обморок, чрезвычайно редки и, как правило, неспецифичны [10].…”

Chronic graft-versus-host disease – the role of dermatological treatment

“…The entire procedure takes approximately 3-4 hours. It is usually performed during 2 consecutive days and repeated every 2-4 weeks [11,12]. ECP was first used in 1987 for the treatment of the erythrodermic form of primary cutaneous T-cell lymphomas [13].…”