Extracorporeal photochemotherapy as second- or first-line therapy of acute GVHD?

Merlin, Étienne; Paillard, Catherine; Rochette, Emmanuelle; David, Arpad; Isfan, Florentina; Doré, Éric; Deméocq, F.; Kanold, Justyna

doi:10.1038/bmt.2009.271

Cited by 16 publications

(19 citation statements)

References 4 publications

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“…ECP has not been associated with the same frequency of viral reactivation and infectious complications as other more immune‐suppressive therapies . ECP has been most successfully applied in hepatitis C–positive patients receiving solid organ transplantation . Therefore, in view of this consideration and of the immune‐modulatory effect rather than the panimmunosuppressive one of ECP, the Expert Panel emphasized the high appropriateness of ECP in this setting.…”

Section: Consensus Statementsmentioning

confidence: 99%

Extracorporeal photopheresis for the treatment of acute and chronic graft‐versus‐host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process

et al. 2013

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Section: Consensus Statementsmentioning

confidence: 99%

Extracorporeal photopheresis for the treatment of acute and chronic graft‐versus‐host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process

et al. 2013

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“…Therefore, current research is focused on therapies without generalized immunosuppression such as extracorporeal photopheresis (ECP) [2]. ECP is often used as a second-line GvHD therapy and even has potential to become a part of the first-line therapy [3]. The main advantage of ECP is the induction of selective immune tolerance instead of unspecific immunosuppression [4].…”

Section: Introductionmentioning

confidence: 99%

In vitro effects of different 8-methoxypsoralen treatment protocols for extracorporeal photopheresis on mononuclear cells

Budde¹,

Berntsch²,

Riggert³

et al. 2017

cejoi

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Extracorporeal photopheresis (ECP) is an important second-line therapy for graft-versus-host disease. A central therapeutic mechanism is the induction of immune tolerance through apoptosis in patient’s leukocytes, caused by ex vivo incubation with 8-methoxypsoralen (8-MOP) and subsequent UVA irradiation.We hypothesized that different 8-MOP incubation times and an additional 8-MOP removal step could influence the apoptosis kinetics of leukocytes in general and in particular could lead to different apoptotic levels in the leukocyte subpopulations. After 8-MOP/UVA treatment of human leukocytes, cells were cultured and the percentage of annexin V positive cells from several leukocyte subpopulations was determined. Only regulatory T cells (Tregs) were relatively resistant to 8-MOP/UVA induced apoptosis. When cells were incubated for 30 minutes with 8-MOP prior to UVA exposure, higher percentages of annexin V positive cells were detected on day 1 and day 2 after treatment. Removal of 8-MOP after UVA exposure caused no significant changes in the apoptosis kinetics during the 72 h culture period compared with unwashed cells. The results of our in vitro study indicate that it could be possible to adjust the apoptosis kinetics via modulation of the 8-MOP incubation time. In further in vivo studies it should be elucidated to which extent different apoptosis kinetics influence the therapeutic effect of ECP since steady-state apoptosis levels are probably important for establishing a long lasting immune tolerance. Furthermore we found that Tregs, according to their well-known tolerogenic function, are more resistant to apoptosis after 8-MOP/UVA treatment compared to GvHD inducing T cell populations.

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“…The frequency of opportunistic infections is not increased by the ECP [12], [13]. Due to its efficacy and the low risk of side-effects, some groups suggest using ECP as part of the first-line therapy for acute GvHD [14]. During the ECP procedure, patient’s own leukocytes are isolated by apheresis.…”

Section: Introductionmentioning

confidence: 99%

Modified Extracorporeal Photopheresis with Cells from a Healthy Donor for Acute Graft-versus-Host Disease in a Mouse Model

et al. 2014

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BackgroundGraft-versus-host disease (GvHD) is a major challenge after hematopoietic stem cell transplantation but treatment options for patients are still limited. In many cases first-line treatment with glucocorticoids is not successful. Among second-line therapies the extracorporeal photopheresis (ECP) is frequently performed, due to induction of selective tolerance instead of general immunosuppression. However, for some patients with severe acute GvHD the leukapheresis step of the ECP procedure is physically exhausting and limits the number of ECP cycles.MethodsWe hypothesized that leukocytes from healthy cell donors could be used as a replacement for ECP leukocytes gained from the GvHD patient. For this purpose we used a well established mouse model of acute GvHD. The ECP therapy was based on cells with the genetic background of the initial donor of the stem cell transplantation. As a precondition we developed a protocol representing conventional ECP in mice equivalent to clinical used ECP setup.ResultsWe could demonstrate that conventional, clinically derived ECP setup is able to alleviate acute GvHD. By using leukocytes obtained from healthy mice with the bone marrow donor’s genetic background we could not observe a statistically significant therapeutic effect.ConclusionsConventional human ECP setup is effective in the mouse model of severe acute GvHD. In addition we could not prove that ECP cells from healthy mice with bone marrow donor’s genetic background are as effective as ECP cells derived from GvHD mice. Based on our findings, new questions arise for further studies, in which the cellular characteristics for ECP mediated immune tolerance are a matter of investigation.

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Extracorporeal photochemotherapy as second- or first-line therapy of acute GVHD?

Cited by 16 publications

References 4 publications

Extracorporeal photopheresis for the treatment of acute and chronic graft‐versus‐host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process

Extracorporeal photopheresis for the treatment of acute and chronic graft‐versus‐host disease in adults and children: best practice recommendations from an Italian Society of Hemapheresis and Cell Manipulation (SIdEM) and Italian Group for Bone Marrow Transplantation (GITMO) consensus process

In vitro effects of different 8-methoxypsoralen treatment protocols for extracorporeal photopheresis on mononuclear cells

Modified Extracorporeal Photopheresis with Cells from a Healthy Donor for Acute Graft-versus-Host Disease in a Mouse Model

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