Review of extracorporeal photopheresis in early‐stage (IA, IB, and IIA) cutaneous T‐cell lymphoma

Abstract

Given the very low side effect profile of ECP compared with other therapies and its demonstrated efficacy, this treatment modality is possibly beneficial for patients with earlier stages of CTCL. Randomized prospective studies are needed to establish the role of ECP in this disease subset.

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“…While clinicians have been successfully treating some CTCL patients with ECP monotherapy (94), others use ECP in combination with other therapies to improve outcomes (92). On average, response rates in CTCL range from 33% to 88% with ECP monotherapy; whereas, multimodality ECP response rates are comparable (94). Collectively across 19 studies, a combined overall response rate of 55.7% was reported across all stages of CTCL with 17.6% achieving a complete response (95).…”

“…CTCL is a rare lymphoproliferative disorder characterized by the accumulation of malignant T lymphocytes in the skin. While clinicians have been successfully treating some CTCL patients with ECP monotherapy (94), others use ECP in combination with other therapies to improve outcomes (92). On average, response rates in CTCL range from 33% to 88% with ECP monotherapy; whereas, multimodality ECP response rates are comparable (94).…”

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“…Treatment of CTCL is currently based on a modified PUVA protocol called extracorporeal photopheresis (ECP) [45,57]. This method is also used to treat other T-cell-mediated ailments, such as organ transplantation and graft-versus-host disease [58].…”

“…First described as a treatment for the erythrodermic stage of CTCL in 1987 by Edelson et al [59], extracorporeal photopheresis is recommended for palliative treatment of skin-related diseases at all stages of CTCL. The mechanism of action of ECP has not been fully elucidated yet, even though the primary target of ECP seems to be the peripheral blood mononuclear cells isolated by the leukopheresis process, and especially lymphocytes that undergo programmed cell death after treatment, whereas monocytes are resistant to the treatment [45]. The photosensitizer 8-MOP is then incorporated in the combined fraction of white cells and plasma, followed by irradiation with UVA light (320-400 nm), and then the treated sample is retransfused to the patient.…”

Progression of a CD4+/CD56+ blastic plasmacytoid DC neoplasm after initiation of extracorporeal photopheresis in an allogeneic transplant recipient

“…GVHD is a common and often serious complication affecting more than 30% of patients after allogeneic SCT. ECP is effective both in chronic GVHD 8 and in cutaneous T-cell lymphoma, 9 so this procedure was started. At 8 months after initiation of ECP, however, the index patient experienced rapid disease progression.…”