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Therapeutic apheresis
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Photopheresis has been used in the setting of solid and hematopoietic transplantation. The postulated rationale for this therapy in the setting of transplantation is that rapidly expanding T-cell clones are preferentially targeted by the induced immune response. Most extensively studied is the use of photopheresis to treat acute rejection and for prophylaxis of rejection in cardiac transplantation. Anecdotal success has been described with acute rejection of cardiac allografts, and one small control study found equal efficacy with corticosteroid therapy (8 of 9 and 7 of 7 reversals of rejection, respectively).74–76 In the largest controlled trial to date of prophylactic photopheresis in cardiac transplantation, 60 patients received standard immunosuppression with or without photopheresis. A greater proportion of patients in the photopheresis group had one rejection episode or none (27 of 33) than in the standard-therapy group (14 of 27), and a smaller proportion of patients in the photopheresis group had two or more rejection episodes (6 of 33) than in the standard-therapy group (13 of 27, p = 0.02).77 However, there was no significant difference in the time to a first episode of rejection, the incidence of rejection associated with hemodynamic compromise, or survival at 6 and 12 months.
Extracorporeal Photopheresis: Principles and Practice
Published in Henry W. Lim, Nicholas A. Soter, Clinical Photomedicine, 2018
Alain H. Rook, Michael H. Berkson, Benjamin R. Vowels
The appropriate future clinical applications of photopheresis will depend upon a thorough understanding of the mechanisms of action of this new therapy. As our comprehension evolves, we will have the capacity to use additional pharmacologic agents together with photopheresis to enhance its therapeutic benefit further. One example is the combined use of interferon alpha with photopheresis in the treatment of CTCL. Photopheresis is in its early phases of use and a great deal remains to be learned.
Extracorporeal Photochemotherapy (Photopheresis)
Published in Henry W. Lim, Herbert Hönigsmann, John L. M. Hawk, Photodermatology, 2007
Robert Knobler, Peter W. Heald
The insight into the mechanism of photopheresis has provided several therapeutic developments that can be tested in future clinical trials. The conjecture that APC play a critical role in photopheresis-induced activation of CD8+ T-cells leads to the conjectured use of cytokines (e.g., GM-CSF) to activate APCs. Injections prior to a session of photopheresis would appear to be the most timely, but post therapy may also be an important time of administration. Not many dimensions of the photopheresis session can be manipulated (both the volume of blood removed and the patient’s willingness to sit for long periods of time have limits); however, the time that the lymphocytes are out of the body may also be increased in an attempt to enhance efficacy (47). Future trials involving these and other adaptations of photopheresis are anticipated.
Preliminary results on long-term follow-up of systemic sclerosis patients under extracorporeal photopheresis
Published in Journal of Dermatological Treatment, 2022
Thilo Gambichler, Olcay Özsoy, Duyen Bui, Christiane H. Scheel, Laura Susok
Systemic sclerosis (SSc) is a relatively rare connective tissue disease characterized by excessive extracellular matrix deposition in the skin and visceral organs. SSc can be classified into 3 different clinical subsets: 1) limited cutaneous SSc (lcSSc), 2) diffuse cutaneous SSc (dcSSc), 3) SSc overlap-syndromes as well as early undifferentiated forms (early and very early SSc) and SSc sine scleroderma. (1,2) It was previously suggested that the immune system plays a major role in the development of vasculopathy and fibrosis. Indeed, the presence of anti-DNA topoisomerase I and anti-centromere auto-antibodies, is a central feature of SSc. Moreover, a wide range of B and T cell abnormalities have been described. (1–5) Based on these pathogenetic characteristics, extracorporeal photopheresis (ECP) was considered for treatment of patients with SSc. ECP procedures involve three stages: 1) leukapheresis, 2) UVA photo-activation with 8‐methoxypsoralen, 3) re-transfusion of the treated buffy coat. Du and colleagues (6) recently published a comprehensive review on ECP in patients with SSc and concluded that multiple lines of evidence suggest that ECP represents a safe and possibly effective treatment modality for patients with SSc. In this study, the effects of ECP treatment on different laboratory parameters and SSc-related long-term survival were analyzed.
Airway disease in hematologic malignancies
Published in Expert Review of Respiratory Medicine, 2022
Ricardo J José, Burton F. Dickey, Ajay Sheshadri
The treatment of BOS is primarily focused on reducing inflammation in the airways through inhaled and systemic anti-inflammatory agents. Inhaled corticosteroids, in combination with a course of oral corticosteroids and/or an increase in immunosuppression, are often effective in halting the progression of BOS [81–83]. Photopheresis can be useful as an adjunctive therapy, but requires an indwelling catheter and proximity to an apheresis center [84]. Other cGVHD therapies, such as ibrutinib [85] and ruxolitinib [86], may have some efficacy in BOS, but most efficacy data is derived from non-lung cGVHD syndromes. Inhaled cyclosporine was previously found to be effective to treat BOS after lung transplantation, but early formulations were associated with a high rate of adverse events [87]. Phase 3 studies of a newer liposomal formulation are underway to treat BOS in lung allograft recipients, and studies in patients with post-HCT BOS are planned. In dire cases, lung transplantation may be necessary [88,89]. Pulmonary rehabilitation is an underutilized supportive treatment that improves the functional capacity of patients with BOS [90]. Other supportive therapies, like inhaled hypertonic saline solution for airway clearance, may improve symptoms, but have not been shown to improve survival.
New nonchemotherapy treatment options for cutaneous T-cell lymphomas
Published in Expert Review of Anticancer Therapy, 2021
Extracorporeal photopheresis (ECP) has been FDA approved as a first line treatment of MF/SS with blood involvement or advanced erythrodermic involvement since 1988[7]. Leucocytes are separated from the patient’s whole blood, mixed with photosensitizing agent 8-methoxypsoralen, and exposed to ultraviolet A light before being reinfused into the patient[56]. In addition to decreasing the viability of irradiated cells, ECP is also thought to have an immunomodulatory effect by normalizing the Th1/Th2 imbalance found in patients with MF/SS[57]. In an initial multi-center study of 37 patients with resistant MF/SS, 73% (27/37) responded to ECP treatment[58]. To date, there are no randomized controlled trials comparing ECP to other standard therapies for MF/SS[59]. Reported adverse events included post-reinfusion temperature elevations and erythema accentuation. ECP may be administered with other therapies such as interferon alfa, vorinostat, and bexarotene[59].