Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

Abstract

Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy which involves separation of the patient's leucocyte-rich plasma, followed by ex vivo administration of a photosensitizer and ultraviolet A radiation, before reinfusion. ECP has been used successfully for the treatment of cutaneous T-cell lymphoma (CTCL: Sézary syndrome), graft-versus-host disease (GVHD) and cardiac transplant rejection. ECP has a dose-sparing effect on concurrent immunosuppressive therapy. The procedure induces apoptosis of the irradiated lymphocytes, but the exact mechanism by which ECP exerts its therapeutic effect in these different conditions is uncertain. The treatment has very few adverse effects and in particular is not associated with an increased incidence of opportunistic infections. The evidence for the efficacy of ECP has been appraised by a combined British Photodermatology Group and U.K. Skin Lymphoma Group workshop on the basis of evidence published up to the end of 2001 and on the consensus of best practice. There is fair evidence for the use of ECP in erythrodermic CTCL and steroid-refractory GVHD, but randomized controlled studies are needed. There is good evidence supporting the use of ECP in preventing cardiac rejection following transplantation. Randomized controlled trials have also shown a therapeutic benefit in type 1 diabetes mellitus, but the inconvenience associated with the procedure outweighed the clinical benefit. There is fair evidence not to use ECP for the treatment of systemic sclerosis and multiple sclerosis, and good evidence not to use ECP for other forms of CTCL.

An update on the clinical utility of extracorporeal photopheresis in the treatment of graft-versus-host disease

“…61 ECP in patients with GVHD does not result in an increased incidence of malignant relapse, and patients undergoing long-term ECP therapy for CTCL and scleroderma do not develop the infections or secondary malignancies that are associated with conventional immunosuppressants. 62,63 Because intravenous access is required to perform ECP, patients are at risk for catheter-related complications including infection and thrombosis. Kanold et al 57 reported that 2.5% (19 of 750) ECP procedures in 27 children were prematurely suspended due to CVL-related issues.…”

Infusion of UVB-treated splenic stromal cells induces suppression of β cell antigen-specific T cell responses in NOD mice

“…Indeed, Maeda et al [11] reported that intravenous injection of apoptotic syngeneic splenocytes led to immune tolerance specific to DNFB antigens simultaneously administered to the skin during induction of contact hypersensitivity. Recent evidence has also shown that T1D patients benefited from photopheresis, which is proposed to be associated with photopheresis-induced apoptosis of blood cells [26].…”

Fotoféresis en el tratamiento de Síndrome de Sézary: Caso clínico

“…Estudios siguientes demostraron respuestas que varían entre 31 y 86% en 5 a 6 meses, dependiendo del paciente seleccionado, la frecuencia de tratamiento y el uso de terapias coadyuvantes 23,24 .…”