Technical comparison of four different extracorporeal photopheresis systems

Abstract

BACKGROUND Extracorporeal photopheresis (ECP) is a therapeutic technique that combines leukapheresis and ultraviolet (UV)A irradiation of the leukapheresate after 8‐methoxypsoralen treatment with subsequent retransfusion. It can be achieved with a single device (online) or by combining an apheresis machine with a separate UVA light source (offline). The comparability of both established methods is unknown. STUDY DESIGN AND METHODS In a prospective setting, four ECP systems were evaluated: one with integrated UVA irradiation for online ECP (Therakos) and three with external UVA irradiation for offline ECP (Amicus, Optia, and Cobe Spectra). Apheresis variables and cell counts were determined by methods including flow cytometry. RESULTS The duration of apheresis ranged from 120 minutes (Amicus, Optia) to 275 minutes (Therakos). Mononuclear cell (MNC) counts in the treatment bags were comparable between offline ECP methods (median, 57 × 108 – 66 × 108) and lower for online ECP (14 × 108). CD16+ monocytes were abundant in online ECP (82%) but rarer in offline ECP (median, 14% – 19%). Hematocrit ranged from 0.1% (Therakos) to 8% (Amicus). There were no side effects in any patients. DISCUSSION All offline ECP systems studied yielded comparable cellular compositions and highly enriched populations of MNCs. In contrast, white blood cells from online ECP displayed enrichment of nonclassical monocytes. The relevance of these findings is unknown as there is no established biomarker to predict the therapeutic efficacy of these procedures.

Mononuclear cell collection for extracorporeal photopheresis by using the “off‐line” system: A comparative study between COBE Spectra and Spectra Optia devices

“…We have observed higher nontargeted cells contamination in the Spectra Optia group. This is contradictory with previously published studies, which mainly reported larger granulocyte 13,[22][23][24] and red blood cell (RBC) contaminations 13,25 with the COBE Spectra device. Despite higher granulocyte contaminations in our Spectra Optia group, it remained lower than those reported by Del Fante et al 21 13 Even if most of the products showed a low granulocyte contamination (<30%), a total of 30 procedures showed an unusually high granulocyte contamination (>30%).…”

“…We have observed higher nontargeted cells contamination in the Spectra Optia group. This is contradictory with previously published studies, which mainly reported larger granulocyte and red blood cell (RBC) contaminations with the COBE Spectra device. Despite higher granulocyte contaminations in our Spectra Optia group, it remained lower than those reported by Del Fante et al (9.1 ± 16% on CMNC and 12.2 ± 19.1% on MNC) and within the range of Del Fante et al (3.8 (2.8‐6.4)%) for MNC products in 2013 .…”

Favorable impact of extracorporeal photopheresis in acute and chronic graft versus host disease: Prospective single‐center study

“…More importantly, our study with the long‐term follow‐up confirms that ECP causes no major side effects. Despite the lack of randomized studies comparing different ECP methods, it seems that the online method used in this study is safe in adult patients with lower hemoglobin values . It only requires frequent visits and central vein access that are either way necessary in patients suffering from severe aGVHD or extensive cGVHD.…”

“…Despite the lack of randomized studies comparing different ECP methods, it seems that the online method used in this study is safe in adult patients with lower hemoglobin values. 28 It only requires frequent visits and central vein access that are either way necessary in patients suffering from severe aGVHD or extensive cGVHD. Although no head-to-head comparisons with other second-line agents are feasible, it should be noted that novel agents are continuously being studied in GVHD.…”

An update on the clinical utility of extracorporeal photopheresis in the treatment of graft-versus-host disease

“…However, the clinical significance of these findings is unclear. 16 Our group here at Children's National compared the two most frequently used instruments, the Uvar XTS and Cellex, by performing a retrospective analysis of 10 pediatric patients who have received ECP for SR-GVHD (both acute and chronic). Compared to the Uvar XTS1 instrument, use of the Cellex instrument resulted in shorter runtimes, increased percentage of mononuclear cells treated, reduced incidence of line occlusions requiring tissue plasminogen activator (TPA) treatment and decreased incidence of patient-related complications.…”