Inline and offline extracorporeal photopheresis: Device performance, cell yields and clinical response

Abstract

Background: Extracorporeal photopheresis (ECP) is an effective treatment for graft-vs-host-disease (GvHD). Photopheresis can be performed in offline or inline method. The first uses a conventional cell separator for collection of mononuclear-cells that are photoactivated by a separate device and manually reinfused; the second one involves a dedicated device performing the entire procedure (collection, photoactivation and reinfusion). Study design and methods: The objective was to compare the two methods and cell product features to highlight key process, devices performance, and to evaluate ECP clinical response. Patients developing steroid-resistant GvHD underwent ECP as second-line treatment using either inline (Therakos CellEx) or offline system (Terumo BCT Spectra or Optia and UVA PIT system). Data about patients' features, pre-apheresis blood-count, cell product characteristics and clinical response were collected for analysis. Results: We evaluated 494 procedures performed on 28 patients from April 2018 to March 2019. The offline procedure allows to achieve greater cell yield, it is characterized by larger processed blood volume, longer runtime, and higher ACD consumption. The inline procedure shows shorter runtime, high mononuclear-cells percentage and low percentage of granulocytes in cell product. We observed a significant difference in cell yields between inline and offline system; furthermore we did not find a significant relationship between cell dose and clinical response. Conclusion: Inline ECP is fast, highly automated and productive, making it particularly suitable for ECP treatments. Offline ECP collects high cell yields implying longer procedure and greater operator intervention. Our study did not find a significant relationship between cell dose and GVHD response.

Mechanisms of Action of Extracorporeal Photopheresis in the Control of Bronchiolitis Obliterans Syndrome (BOS): Involvement of Circulating miRNAs

“…The technique adopted to perform the procedure (inline or off-line) does not seem to influence the clinical response to the treatment. Nonetheless, some differences exist regarding the patient’s management and the product collected [ 32 , 33 ]. A paired trial compared mononuclear cell collection in two machines for the further inactivation through an inline or offline extracorporeal photopheresis procedure [ 34 ].…”

Extracorporeal photopheresis in the treatment of acute and chronic graft-versus-host disease: A position statement from the Turkish Society of Apheresis (TSA)

“…Apart from these, many observational, prospective and retrospective studies support the early use of cGVHD in post-steroid treatments, due to the excellent safety profile of ECP and its graft versus leukemia effect being unaffected by ECP [58][59][60].…”

Optimierung der extrakorporalen Photopherese

“…In der Zellzusammensetzung wurden zwischen der "inline"-und der "offline"-ECP Unterschiede dahingehend festgestellt, als dass die gewonnene Zelldosis bei dem "offline"-Verfahren mit ungefähr 60 × 10 8 Leukozyten doppelt so hoch war wie bei der "inline"-ECP [12]. Mit der Frage nach der wirksamen Zelldosis haben sich verschiedene Forschungsgruppen beschäftigt, wobei eine eindeutige Zellmenge als therapeutische Mindestdosis noch nicht definiert werden konnte [2]. Es wurde jedoch ein Zusammenhang zwischen der Dosis MNZ/kg und Lymphozyten/kg und dem Ansprechen auf die ECP beobachtet [13].…”