Treatment of systemic sclerosis with extracorporeal photochemotherapy. Results of a multicenter trial

Rook, Alain H.

doi:10.1001/archderm.128.3.337

Cited by 117 publications

(120 citation statements)

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“…20 Subsequently, several autoimmune T cell-mediated processes have been treated successfully, including pemphigus vulgaris, 21 systemic lupus erythematosus 22 and scleroderma. 23 It has also been reported as effective in the prevention of solid organ transplant rejection. 24 The mechanism by which ECP is thought to work is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)

Child

Ratnavel

Watkins

et al. 1999

Bone Marrow Transplant

158

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Summary:The aim of our study was to assess the efficacy of extracorporeal photopheresis (ECP) in chronic graft-versushost disease (GVHD). Eleven patients with chronic cutaneous GVHD were studied. Four had mucosal involvement and five had pulmonary involvement. All had failed to improve on first-and second-line therapy. Three patients received ECP alone; the remainder continued to receive steroids and/or immunosuppressive therapy. Patients received ECP twice monthly for 4 months and then once monthly for 3 months. They were evaluated by serial skin scores, mucosal and skin photography, pulmonary function tests, biochemical and haematological parameters. Nine patients showed objective evidence of cutaneous improvement with a mean reduction in skin score of 48% overall. In the 10th patient, skin scores and oral involvement improved on twice monthly ECP but deteriorated when reduced to once monthly. The final patient died from renal failure secondary to cyclosporin toxicity. Two out of five patients with lung involvement showed a mild improvement in pulmonary function tests. Liver function tests were abnormal in five patients; they improved in one and deteriorated in three. All patients receiving concomitant immunosuppressive/steroid therapy were able to reduce drug dosages by trial completion. Our results indicate that ECP can benefit patients with cutaneous and mucosal chronic GVHD who have failed on firstand second-line therapies. The effect on the systemic manifestations of GVHD is less consistent.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)

Child

Ratnavel

Watkins

et al. 1999

Bone Marrow Transplant

158

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“…Although the mechanisms are less clear, ECP has also demonstrated similar efficacy in a number of autoimmune disorders, including scleroderma, pemphigus vulgaris, rheumatoid arthritis, systemic lupus erythematosis, and solid organ allograft rejection (Table 1). 22,[24][25][26][27][28] …”

Section: Extracorporeal Phototherapymentioning

confidence: 99%

Extracorporeal photopheresis in chronic graft-versus-host disease

Foss

Görgün

Miller

2002

Bone Marrow Transplant

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“…7 Briefly, 2 h after the ingestion of 0.6 mg of 8-methoxypsoralen per kilogram body weight, patients underwent a discontinuous leukapheresis procedure with exposure of removed leukocytes to ultraviolet A radiation within the UVAR device. During the procedure, approximately 240 ml of leukocyteenriched blood is mixed with 300 ml of the patient's plasma and 200 ml of sterile normal saline plus approximately 10 000 U of heparin.…”

Section: Patients and Therapymentioning

confidence: 99%

“…4,5 Photopheresis, a leukapheresis-based therapy that combines 8-methoxypsoralen and ultraviolet A irradiation, has recently been shown to be an effective treatment for advanced cutaneous T cell lymphoma (CTCL), but has also shown efficacy in cGVHD. [6][7][8] In CTCL, clinical responsiveness to photopheresis has been shown to be dependent on the presence of detectable circulating clonal T cells in the peripheral blood. 6 Given the responsiveness of certain, but not all, cases of cGVHD to photopheresis, we investigated whether circulating clonal T cell populations are detectable in cGVHD patients, and if their presence could predict clinical response to photopheresis, as is the case in CTCL.…”

mentioning

confidence: 99%

Identification of amplified clonal T cell populations in the blood of patients with chronic graft-versus-host disease: positive correlation with response to photopheresis

French

Alcindor

Shapiro

et al. 2002

Bone Marrow Transplant

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Summary:Chronic graft-versus-host disease (cGVHD) is a multiorgan disorder with skin manifestations resembling scleroderma. Since photopheresis, a treatment that induces an anticlonotypic immune response, has proven to be effective in both cutaneous T cell lymphomas with circulating clonal T cells and in cGVHD, we have searched for circulating clonal T cell populations in patients with cGVHD, and determined whether T cell clonality in the blood is associated with therapeutic response. We screened blood samples from 27 patients after HLA-matched allogeneic bone marrow transplantation (allo-BMT), 10 without cGVHD and 17 with extensive cGVHD, for clonal T cell receptor ␥ (TCR␥) gene rearrangements using fluorescent-based polymerase chain reaction (PCR) and automated high-resolution capillary electrophoresis. Amplified populations of clonal T cells with unique TCR␥ gene rearrangements were found in six of 10 (60%) allo-BMT patients without cGVHD and 13 of 17 (76.5%) allo-BMT patients with cGVHD (P = 0.41), as compared to none of 10 (0%) healthy controls. Twelve patients with cGVHD were treated by photopheresis, and the presence of amplified populations of clonal T cells was found to be associated with a cutaneous response to photopheresis, as eight of eight (100%) clone-positive vs none of four (0%) clonenegative patients experienced a clinically significant cutaneous response to treatment (P = 0.001). Our findings suggest that patients with cGVHD that have detectable expanded clonal T cell populations in their peripheral blood, may be more likely to respond to treatment by photopheresis.

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Treatment of systemic sclerosis with extracorporeal photochemotherapy. Results of a multicenter trial

Cited by 117 publications

References 0 publications

Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)

Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)

Extracorporeal photopheresis in chronic graft-versus-host disease

Identification of amplified clonal T cell populations in the blood of patients with chronic graft-versus-host disease: positive correlation with response to photopheresis

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