03/22/2018 - Pirouette | 12:00pm - 12:30pm
Plenary Lecture 1 | Photopheresis
|Extracorporeal Photochemotherapy,Photopheresis Update 2018
1 Medical University of Vienna, Dermatology, Vienna, Austria
Abstract text :
Extracorporeal photopheresis (ECP), is an FDA approved therapy for the Sezary syndrome variant of cutaneous T-cell lymphoma (CTCL) and established therapy for other indications such as acute and chronic Graft versus Host Disease, control of lung and heart transplant rejection and early Systemic and refractory localized Sclerosis. As of 2018, this therapy has been firmly established and included in a number of consensus criteria statements as first line treatment of the Sezary syndrome including the EORTC CTCL guidelines, U.K. photopheresis recommendations, USCLC, EDF, and other guidelines. Recently combination therapies which include interferon alfa, Bexarotene, TSEB, PUVA and others suggest enhancement of response and increase in long term survival in CTCL patients. As referred, ECP has been shown to be effective in a number of other T-cell mediated diseases: indications in dermatology include systemic sclerosis, refractory localized scleroderma, nephrogenic fibrosing dermopathy (NFD), refractory lichen planus of the mucous membranes, severe refractory atopic dermatitis and pemphigus vulgaris. In hematology ECP has become a widely accepted second line treatment for acute and chronic Graft versus Host Disease after allogeneic bone marrow transplantation, being recommended as a second line treatment by the European EBMT consensus group. Efficacy has been shown in the control of rejection in the area of solid organ transplants, particularly heart and most recently lung transplant rejection. In addition recent data appears to confirm efficacy in indications such as therapy refractory Ulcerative colitis/ Crohn’s disease and prevention or amelioration of Type I diabetes in children. This therapy has become available in over 200 centers within the US and Europe with further introduction of centers in Asia and Latin America.
The procedure itself has been modified slightly since its first description in 1985. The procedure now utilizes exclusively drug deliv¬ery direct into the leucocyte collection bag. Treatment cycles consisting of two back to back treatments on consecutive days vary based on indication, response and nature of the disease.
Based on the available literature on the use of ECP in the past 30 years with over 1,5 million performed treatments ECP has been shown to be very well tolerated with an excellent safety profile. Once the mechanisms of action for which recent and on-going studies have unveiled a number of very promising and reproducible leads are better understood, a more rational approach to the utilization of this modality should additionally benefit future patients. Appro¬priately designed controlled studies investigating combination therapies, schedules and varying treatment intensities are still necessary to further contribute in maximizing the impact of ECP in an interdisciplinary setting.