Extracorporeal photochemotherapy in patients with cutaneous T‐cell lymphoma: is clinical response predictable?

Rao, Vidar; Ryggen, Kristin; Aarhaug, M; Dai, Hongyue; Jørstad, Størker; Moen, Torolf

doi:10.1111/j.1468-3083.2006.01745.x

Cited by 14 publications

(8 citation statements)

References 39 publications

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“…Some studies suggested that LDH values could be regarded as an additional marker potentially associated with ECP response, 62,71 even if others did not completely confirm these findings. 67 On the other hand, what becomes evident from our data is that patients with a high tumor burden in the peripheral blood show a more aggressive clinical behavior and a significantly lower response to ECP; a possible suggestion in these patients could be therefore to establish a treatment able to induce a significant reduction in circulating leukemic cells and then initiate ECP.…”

Section: Resultsmentioning

confidence: 87%

“…Some studies suggested that LDH values could be regarded as an additional marker potentially associated with ECP response, even if others did not completely confirm these findings …”

Section: Resultsmentioning

confidence: 99%

“…Based on these criteria, we identified 28 studies, in the majority of cases retrospective and based on single institution series. A total of 407 patients reported as erythrodermic were included (Table ) …”

Section: Extracorporeal Photopheresis For the Treatment Of Erythrodermentioning

confidence: 99%

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Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T‐cell lymphoma: a single center clinical experience with long‐term follow‐up data and a brief overview of the literature

et al. 2013

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Extracorporeal photopheresis (ECP) is a therapeutic procedure in which leukapheresed peripheral blood mononuclear cells are exposed to ultraviolet A in the presence of the photosensitizer 8-methoxypsoralen and then reinfused. Several guidelines recommend ECP as a treatment of choice in erythrodermic primary cutaneous T-cell lymphomas (E-CTCL). However, the level of evidence is low due to the rarity of this disease and the lack of randomized controlled trials. We performed a review of the English literature, restricting our analysis to studies including erythrodermic patients and more than 10 cases. Based on these criteria, we identified 28 studies, with a total of 407 patients. The median response rate in erythrodermic patients was 63% (range 31-86%), with a complete response rate ranging between 0 and 62% (median 20%). In our experience, we treated 51 patients with E-CTCL since 1992. A clinical response was obtained in 32 of 51 patients (63%), with a 16% complete response rate. The median time for response induction was eight months (range: 1-23). The median response duration was 22.4 months (range six months to 11 years). The treatment was generally well tolerated without systemic toxicities grade III-IV. The pretreatment parameters significantly associated with a higher likelihood to obtain a clinical response were the B-score in the peripheral blood, CD4/CD8 ratio, and amount of circulating CD3+CD8+ cells. Literature data together with our personal experience clearly support the clinical activity and tolerability of ECP in patients with E-CTCL. Prospective controlled clinical trials are strongly recommended to better document the evidence.

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Section: Resultsmentioning

confidence: 87%

“…Some studies suggested that LDH values could be regarded as an additional marker potentially associated with ECP response, even if others did not completely confirm these findings …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T‐cell lymphoma: a single center clinical experience with long‐term follow‐up data and a brief overview of the literature

et al. 2013

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“…45 This criterion does allow treatment of patients with a peripheral blood clone who may not have a high peripheral blood burden as this subset of patients may benefit from ECP. 46,47 The presence of a peripheral blood T-cell clone was included as a minor criterion as the presence of a peripheral blood T-cell clone does not correlate with response to ECP, 48,49 but these patients without a demonstrable clone would have to have other evidence of peripheral blood involvement such as a raised CD4 ⁄CD8 ratio > 10 or Sézary cell count > 10%. There is not enough literature on the treatment of erythrodermic CTCL without peripheral blood involvement to determine if this group of patients may benefit from ECP although some centres have noted a response in these patients.…”

Section: Patient Selection For Extracorporeal Photopheresis In Patienmentioning

confidence: 99%

U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease

Scarisbrick¹,

Taylor²,

Holtick³

et al. 2008

Br J Dermatol

155

113

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Extracorporeal photopheresis (ECP) has been used for over 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (cGVHD). The lack of prospective randomized trials has led to different centres having different patient selection criteria, treatment schedules, monitoring protocols and patient assessment criteria. ECP for CTCL and cGVHD is available only at six specialized centres across the U.K. In the recent Improving Outcomes Guidance the National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and because of the complexity of treatment supported its use in specialized centres and also suggested the need for expansion of this service. In 2005 consultants and senior nurses from all U.K. sites and from Scandinavia formed a Photopheresis Expert Group. This group's first aim was to produce a consensus statement on the treatment of CTCL and cGVHD with ECP using evidence-based medicine and best medical practice, in order to standardize ECP eligibility, assessment and treatment strategies across the U.K.

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“…Due to the findings of monoclonal T‐cells in peripheral blood of patients with CTCL, one explanation has been that ECP induces an anti‐clonotypic cytolytic immunity directly against tumour cells [17]. However, response has also been observed in CTCL patients lacking such a clone [38]. A major issue in CTCL, is whether ECP is inducing specific cytotoxicity to the lymphoma cells or alternatively is inducing specific or non‐specific regulatory T‐cells controlling the CTCL proliferation.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Experiments Demonstrate that Monocytes and Dendritic Cells are Rendered Apoptotic by Extracorporeal Photochemotherapy, but Exhibit Unaffected Surviving and Maturing Capacity after 30 Gy Gamma Irradiation

Rao

Saunes²,

Jørstad³

et al. 2008

Scand J Immunol

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Extracorporeal photochemotherapy (ECP) has been shown to induce apoptosis in lymphocytes. Until recently the prevailing opinion has been that the monocytes were mainly not affected by this treatment. This study has investigated the effect of ECP and gamma irradiation on monocytes and immature dendritic cells (DC) in vitro and followed the ability of the cells to differentiate and survive post treatment. ECP induced apoptosis in lymphocytes, monocytes and immature DC within 72 h following treatment, in contrast to 30 Gy gamma irradiation, which seemed mainly to affect lymphocytes. The minority of the surviving ECP‐treated monocytes presented a reduced ability to differentiate into immature DC within this time frame. We also demonstrated that immature DC after ECP‐treatment lost their normal ability to mature on stimulation with lipopolysaccharide. As monocytes and immature DC seem to have a reduced ability to differentiate after ECP‐treatment, it is suggested that the therapeutic effect of ECP is caused by in vivo effects of reinfused apoptotic cells, rather than by infusion of monocytes induced to differentiate into immature DC.

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Extracorporeal photochemotherapy in patients with cutaneous T‐cell lymphoma: is clinical response predictable?

Cited by 14 publications

References 39 publications

Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T‐cell lymphoma: a single center clinical experience with long‐term follow‐up data and a brief overview of the literature

Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T‐cell lymphoma: a single center clinical experience with long‐term follow‐up data and a brief overview of the literature

U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease

In Vitro Experiments Demonstrate that Monocytes and Dendritic Cells are Rendered Apoptotic by Extracorporeal Photochemotherapy, but Exhibit Unaffected Surviving and Maturing Capacity after 30 Gy Gamma Irradiation

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