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Review
. 2020 Jun;47(3):214-225.
doi: 10.1159/000508169. Epub 2020 May 19.

Extracorporeal Photopheresis in Graft-versus-Host Disease

Beatrice Drexler  1   2 , Andreas Buser  1   2 , Laura Infanti  1   2 , Gregor Stehle  1   2 , Joerg Halter  1 , Andreas Holbro  1   2
Affiliations
Review

Extracorporeal Photopheresis in Graft-versus-Host Disease

Beatrice Drexler et al. Transfus Med Hemother. 2020 Jun.

Abstract

Background and summary: Extracorporeal photopheresis (ECP) is a leukapheresis-based procedure used in the therapy of acute and chronic graft-versus-host disease (aGvHD, cGvHD) and other diseases. Based on the substantial efficacy and the excellent safety profile in the absence of immunosuppression ECP has established itself as a major treatment form for steroid-refractory GvHD. Here we review the current literature on ECP as a treatment option for patients with aGvHD as well as cGvHD.

Key messages: ECP is a well-established second-line therapy for cGvHD. Its role in the treatment of aGvHD is less clear but also points towards an effective second-line therapy option. In the future ECP could play a role in the prevention of GvHD. More experimental and randomized controlled trials are needed to define the best patient selection criteria, settings, and therapy regimens for GvHD.

Keywords: Extracorporeal photopheresis; Graft-versus-host disease; Treatment.

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Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Procedure and mode of action. Stages of the procedure and the hypothesis for the mode of action. (1) MNC are separated from peripheral blood (buffy coat) and concentrated before ex vivo incubation with 8-MOP and photoactivation by UVA-irradiation. (2) ECP-treated lymphocytes undergo apoptosis. (3) Differentiation of immature dendritic cells are triggered by contact of these cells with extracorporeal surfaces. (4) Recognition of apoptotic cells induces an anti-inflammatory response with a lower production of proinflammatory cytokines and a higher production of anti-inflammatory cytokines. (5) Antigen-presenting cells promote generation of regulatory T cells. (6) Reinfusion of irradiated cells into the patient.
See this image and copyright information in PMC

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