Assessing the potential role of photopheresis in hematopoietic stem cell transplant

Abstract

The First International Symposium on Photopheresis in Hematopoietic Stem Cell Transplantation was held in Vienna, Austria with an educational grant from Therakos Inc. from 25 May to 27 May 2005. Three general issues were addressed: (1) pathophysiology of graft-versus-host disease (GvHD), (2) induction of immune tolerance and the immunology of phototherapy and (3) current standard treatment and prevention strategies of acute and chronic GvHD and the use of extracorporeal photopheresis (ECP). The objectives of the meeting were to open a dialogue among leading researchers in photobiology, immunology, and hematopoietic stem cell transplantation; foster discussions and suggestions for future studies of the mechanism of action of ECP in acute and chronic GvHD; and promote collaboration between basic scientists and clinicians. As can be seen from the summaries of the individual presentations, important advances have been made in our understanding of GvHD, including the use of photoimmunology interventions and the development of robust model systems. It is our expectation that data from photoimmunology studies can be used to generate hypotheses in animal models that can further define the mechanism of action of ECP and help translate the findings to clinical trials of ECP for the prophylaxis and treatment of both chronic and acute GvHD.

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

“…Previous reports have used a variety of schedules and have not reported the effect on QoL using validated questionnaires. [6][7][8][9][10] This is the first prospective study to investigate the effect of a fortnightly schedule of ECP on clinical response and QoL in cGVHD using two validated questionnaires. This report benefits from a standardised regimen of ECP, prospective data accrual, lack of inter-observer variation and stringent use of NIH criteria.…”

“…Seventeen patients had oral disease. Other organs involved included liver (8), eyes (14), gut (7), lung (3) and muscles/joints (6).…”

“…Our group and others have previously reported the efficacy of ECP in the management of cGVHD in retrospective studies. [2][3][4][5] To date, there are only a few prospective studies of ECP for this condition [6][7][8][9] and one randomised prospective trial. 10 In addition, there are few data on the effect of ECP on quality of life (QoL) in patients with cGVHD.…”

Extracorporeal photopheresis in 62 patients with acute and chronic GVHD: Results of treatment with the COBE Spectra System

“…2 Circulating apoptotic cells are phagocytosed by APCs, leading to inhibition of proinflammatory cytokines and induction of regulatory T cells. [3][4][5] ECP may be performed employing two different techniques: an in-line photopheresis system (Therakos, UVAR XTS System, Ascot, Berkshire, UK) and the off-line method (COBE Spectra LRS System). 6 ECP is effective in the treatment of both steroid-refractory and -dependent aGVHD and cGVHD.…”

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

“…UV radiation induces antiproliferative and immunomodulatory effects. In addition, it has an impact on cytokine production, cell activation, antigen presentation and apoptosis of T-cells, among others [10]. Phototherapy has been shown to be an effective therapeutic tool both in the treatment of acute and chronic GVHD.…”