Extracorporeal photopheresis, a therapeutic option for cutaneous T-cell lymphoma and immunological diseases: state of the art

Abstract

ECP is efficacious in a high percentage of those cutaneous T-cell lymphoma patients who have circulating malignant T cells in the context of a still-near-normal immune competence. From the side of graft-versus-host disease (GVHD), the use of ECP showed a clinical benefit in patients with steroid-refractory acute GVHD (aGVHD) and it is believed that ECP deserves to be evaluated as part of a combination strategy in first-line therapy of aGVHD. In chronic GHVD, the published data show that ECP can be effective in extensive and long-standing disease even when treatment is initiated at an advanced stage after conventional immunosuppressive and corticosteroid therapy has failed. ECP should be considered most beneficial for patients with predominantly mucocutaneous chronic GVHD. The fields of application of the procedure could be vast, and could also include autoimmune and metabolic diseases. The most important methodological issues which affect ECP evaluation is that the large majority of data about ECP result from single-arm observational series and the significant efficacy is mainly based on small and retrospective studies. ECP has never been proved to offer any survival advantage in a context of a randomized trial and the above-mentioned limitation also affects the accuracy of many biological modifications observed during ECP. Starting from these considerations, the need of a prospective randomized study becomes increasingly urgent.

Ibrutinib treatment ameliorates murine chronic graft-versus-host disease

“…Intriguingly, ibrutinib treatment beginning on day 28 after HSCT in mice with established cGVHD resulted in resolution of fibrosis, suggesting that treatment in the early phase of cGVHD can permit tissue repair and further suggesting that ongoing antibody deposition in cGVHD target organs may be required for a persistent fibrogenic process. Notably, for patients with debilitating cGVHD from fibrosis, therapies include supportive care, high-dose steroids, rapamycin, mycophenolate, imatinib, extracorporal photopheresis, IL-2, and lung transplant, all with incomplete efficacy and potentially serious complications (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). Although conclusions from rodent cGVHD must be validated in patients, our studies collectively indicate that a wide spectrum of cGVHD patients may benefit from ibrutinib therapy.…”

A transition from using multi‐step procedures to a fully integrated system for performing extracorporeal photopheresis: A comparison of costs and efficiencies

“…This ensures sterility, alleviates the need to cross match re‐infused materials, and reduces the risk of improper infusion, contamination, or infection . The duration of the ECP procedure with fully integrated systems is shorter than procedures requiring multiple steps . In Europe, the only approved fully integrated instruments specifically designed for ECP are the Therakos ® UVAR‐XTS and CELLEX ® systems, which utilize UVADEX ® photosensitizing solution .…”

Cell Death Induced on Cell Cultures and Nude Mouse Skin by Non-Thermal, Nanosecond-Pulsed Generated Plasma

“…However the key effect seems to be that it induces apoptosis of circulating lymphoma cells. These apoptotic cells are re-infused into the patient and generate an anti-tumorogenic immune response [28,29]. The beneficial effects of plasmapheresis are usually temporary.…”