Extracorporeal photopheresis: a review

Area of Science:

• Immunology
• Dermatology
• Transplantation medicine

Background:

• Extracorporeal phototherapy (ECP) involves psoralen and UVA light acting on mononuclear cells.
• Photopheresis is established for advanced cutaneous T-cell lymphoma (CTCL), improving survival and response rates.
• Emerging evidence supports ECP for acute allograft rejection and chronic graft-versus-host disease.

Purpose of the Study:

• To review the efficacy and potential applications of ECP.
• To explore the mechanistic basis of ECP's therapeutic effects.
• To highlight ECP's role in managing refractory autoimmune diseases.

Main Methods:

• Collection of mononuclear cells via apheresis.
• Ex vivo treatment with 8-methoxypsoralen (8-MOP) and ultraviolet A (UVA) light.
• Reinfusion of treated cells into the patient.

Main Results:

• ECP demonstrates significant response rates (50-75%) and survival benefits in CTCL.
• Photopheresis is effective in managing acute allograft rejection across various transplant types.
• ECP shows potential in treating chronic graft-versus-host disease and certain autoimmune conditions.

Conclusions:

• ECP is a valuable therapeutic modality for CTCL and shows promise in transplantation and autoimmune disorders.
• The mechanism involves inducing anticlonotypic immunity and T-cell apoptosis.
• Further research may expand ECP's application in resistant autoimmune diseases.