Photopheresis in Cutaneous T-Cell Lymphoma: Five-Year Experience

Crovetti, G; Carabelli, Anna M.; Berti, Emilio; Guizzardi, M.; Fossati, Sabrina; Filippo, Carlotta De; Bertani, E.

doi:10.1177/039139880002300109

Cited by 34 publications

(7 citation statements)

References 21 publications

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“…Reported overall response rates vary between 31% and 86% (see Table 1). 1,55–69 CR rates, however, are much lower, ranging from 0 to 33%. Different response rates may relate to differences in entry criteria such as the presence of a peripheral blood T‐cell clone, prior or adjuvant therapy, interval between diagnosis and treatment, ECP protocol, duration of ECP and definition of treatment response.…”

Section: Extracorporeal Photochemotherapy For Cutaneous T‐cell Lymphomamentioning

confidence: 95%

Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

Rhodes

et al. 2005

British Journal of Dermatology

113

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Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy which involves separation of the patient's leucocyte-rich plasma, followed by ex vivo administration of a photosensitizer and ultraviolet A radiation, before reinfusion. ECP has been used successfully for the treatment of cutaneous T-cell lymphoma (CTCL: Sézary syndrome), graft-versus-host disease (GVHD) and cardiac transplant rejection. ECP has a dose-sparing effect on concurrent immunosuppressive therapy. The procedure induces apoptosis of the irradiated lymphocytes, but the exact mechanism by which ECP exerts its therapeutic effect in these different conditions is uncertain. The treatment has very few adverse effects and in particular is not associated with an increased incidence of opportunistic infections. The evidence for the efficacy of ECP has been appraised by a combined British Photodermatology Group and U.K. Skin Lymphoma Group workshop on the basis of evidence published up to the end of 2001 and on the consensus of best practice. There is fair evidence for the use of ECP in erythrodermic CTCL and steroid-refractory GVHD, but randomized controlled studies are needed. There is good evidence supporting the use of ECP in preventing cardiac rejection following transplantation. Randomized controlled trials have also shown a therapeutic benefit in type 1 diabetes mellitus, but the inconvenience associated with the procedure outweighed the clinical benefit. There is fair evidence not to use ECP for the treatment of systemic sclerosis and multiple sclerosis, and good evidence not to use ECP for other forms of CTCL.

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Section: Extracorporeal Photochemotherapy For Cutaneous T‐cell Lymphomamentioning

confidence: 95%

Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

Rhodes

et al. 2005

British Journal of Dermatology

113

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“…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%

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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“…Those studies in which SS has been clearly defined and an OR defined as at least 50% clearing are shown in Table I. 84,90,151,[153][154][155][156][157][158] However, there are notable publications where response in patients with SS to ECP (given as 2 consecutive days monthly) is defined only as at least 25% clearing. Not surprisingly, the RR is higher in these cases: de Misa et al 158 reported on 60% response in the skin in 10 patients with SS (defined as T 4 1 [5% peripheral blood SC 1 clonal involvement) and Evans et al 159 noted a response in skin in 57% of patients with SS (defined stringently as T 4 , $ 10% peripheral blood SC, and clonality TCR gene rearrangement).…”

Section: Extracorporeal Photopheresismentioning

confidence: 99%

Sézary syndrome: Immunopathogenesis, literature review of therapeutic options, and recommendations for therapy by the United States Cutaneous Lymphoma Consortium (USCLC)

Olsen

Rook

Zic

et al. 2011

Journal of the American Academy of Dermatology

155

135

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Photopheresis in Cutaneous T-Cell Lymphoma: Five-Year Experience

Abstract: In our experience ECP achieved favourable clinical responses in 73% of patients, in monotherapy or in combination with IFN-alpha, without significant side effects.

Cited by 34 publications

References 21 publications

Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

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

Sézary syndrome: Immunopathogenesis, literature review of therapeutic options, and recommendations for therapy by the United States Cutaneous Lymphoma Consortium (USCLC)

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