Guidelines on the use of extracorporeal photopheresis

Abstract

BackgroundAfter the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease.Materials and methodsIn order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task.Results and conclusionThese guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion.

Kutane Graft-versus-Host-Erkrankung

“…Durch Retransfusion der so behandelten Zellen wird vermutlich eine Immuntoleranz durch veränderte Zytokinausschüttung und Stimulierung regulatorischer T-Zellen hervorgerufen. Die ECP stellt eine nebenwirkungsarme und effektive Therapie sowohl der akuten als auch der chronischen GvHD dar und bietet zusätzlich den Vorteil, immunsupprimierende Medikamente zu sparen und mit ihnen verbundene Nebenwirkungen zu reduzieren [22]. Greinix et al [16] konnten bei II.-bis IV.-gradiger aGvHD mit kutaner Beteiligung mittels ECP eine Remissionsrate von 82 % erzielen.…”

“…Selten, aber dennoch beschrieben, ist das Auftreten der GvHD nach Transfusion von Blutprodukten [30], Organtransplantation (Leber, Niere; [18,29]) sowie nach autologer HSZT [1,22,23]. Bei etwa 40-60 % der Patienten kann sich diese immunmediierte Komplikation im Anschluss an die HSZT entwickeln.…”

Therapeutic options for bronchiolitis obliterans Syndrome after lung transplantation

“…The underlying mechanisms of ECP have not fully been elucidated to date. However, major factors include the induction of apoptosis, modulation of T regulatory cells, and induction of immune tolerance (37)(38)(39).…”

Therapeutic apheresis: Technical modalities and therapeutic applications

“…As a result it improves the clinical inflammatory status of patients. The regimen involves direct hemoperfusion, in which whole blood is applied to the column for the adsorption of leukocytes onto the nonwoven hydrophilic polypropylene fabric of the column [13] Extracorporeal photochemotherapy (ECP): is a form of apheresis therapy and involves light-activated treatment of circulating blood cells outside the body (Therakos UVAR XTS Phototheresis System) [14].…”