Clinical Results of Extracorporeal Photopheresis

Abstract

Extracorporeal photopheresis (ECP) is a combination of leukapheresis and photodynamic therapy in which blood is treated with photoactivable drugs which are then activated with ultraviolet light and re-infused to the patient. It has been used successfully for more than 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (GVHD). ECP has also shown promising results in the treatment of acute GVHD and other T-cell-mediated diseases, including systemic sclerosis, treatment and prevention of solid organ rejection, and more recently Crohn's disease. The use of ECP may allow a significant reduction or even discontinuation of corticosteroids and/or other immunosuppressants, thus leading to reduced long-term morbidity and mortality and improved overall survival. ECP is a well-tolerated therapy. No significant side effects have been reported during the last 30 years. It has been shown that ECP is not associated with an increased incidence of infections, malignancies, or recurrence of underlying malignant disease, neither during short-term nor during long-term therapy.

Fig. 1

During ECP whole blood is drawn from the patient and separated in plasma and different cell fractions. MNCs are collected, incubated with 8-MOP, photoactivated with UVA light and re-infused to the patient.

Fig. 2

Kaplan-Meier probability of overall survival among patients with steroid-refractory and-dependent acute GVHD was significantly higher among those showing complete response (CR) to ECP (black line) compared with those with no CR to ECP (grey line). This figure was published in Greinix, et al: The effect of intensified extra-corporeal photochemotherapy on long-term survival in patients with severe acute graft-versus-host disease. Haematologica 2006;91:405–408, Copyright © 2006 Ferrata Storti Foundation.

Fig. 3

Cumulative incidence of complete or partial response of skin was higher among patients with steroid-refractory/-dependent/-intolerant chronic GVHD treated with ECP than in the control group. This figure was originally published in Flowers et al: A multicenter prospective phase 2 randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease. Blood 2008;112:2593–2594, Copyright © 2008 The American Society of Hematology.