Extracorporeal photopheresis practice patterns: An international survey by the ASFA ECP subcommittee

Abstract

This survey based study describes current ECP practices. Further research to provide evidence for optimal standardization of patient qualifications, procedure parameters and product quality assessment is recommended.

Safety and collection efficiency with a lower transfusion threshold for extracorporeal photopheresis in adult patients with graft‐versus‐host disease

“…We chose 25% rather than 24% as the lower boundary for this cohort due to the consideration that a 250 ml preprocedural bolus (5% albumin) may reduce the haematocrit further by about 1% in a typical adult patient. However, other centres have reported using a haematocrit threshold as low as 24% in a recent survey .…”

“…This practice intends to limit the extracorporeal volume within a specific proportion of the calculated total blood volume to improve patient safety, and to ensure successful collection of the buffy coat. A recent international survey showed frequent use of preprocedural haematocrit of 24–28% as eligibility thresholds for ECP . The rationale and evidence for our and others practices have not been documented in the literature.…”

Extracorporeal photopheresis in pediatric patients: Practical and technical considerations

“…Although case series in pediatric patients have focused on ECP's use in GVHD, ECP is a widely‐used modality, with many centers exploring its use in diseases not mentioned or currently listed as category III indications in the ASFA guidelines, including inflammatory bowel diseases, scleroderma, and pemphigus vulgaris, to name a few . Even in adult patients, health care practitioners are using ECP without fully understanding its mechanism of action, how to adequately dose and schedule it, or an appropriate treatment and tapering schedule.…”

Indication‐specific immunomodulatory effects of extracorporeal photopheresis: A pilot study in heart transplanted patients

“…The majority of the results about the ECP‐induced cellular and cytokine changes originate from studies on graft‐versus‐host disease. A few centers perform quality control testing of the cellular product before its reinfusion, but laboratory parameters to qualify ECP are missing …”

“…Second, the ECP product was not characterized in our study. Although quality control assessment of the ECP cellular product is not required, ECP‐applying institutions recommend to routinely perform quality control testing of ECP cellular product including the total cell count, lymphocytes, monocytes, and hematocrit …”