Back to Search Start Over

Extracorporeal photopheresis (photochemotherapy) in the treatment of acute and chronic graft versus host disease: immunological mechanisms and the results from clinical studies.

Authors :
Bruserud, Øystein
Tvedt, Tor
Paulsen, Petter
Ahmed, Aymen
Gedde-Dahl, Tobias
Tjønnfjord, Geir
Slåstad, Heidi
Heldal, Dag
Reikvam, Håkon
Source :
Cancer Immunology, Immunotherapy. Aug2014, Vol. 63 Issue 8, p757-777. 21p.
Publication Year :
2014

Abstract

Extracorporeal photopheresis (ECP) is an immunomodulatory alternative for treatment of graft versus host disease (GVHD). The blood is then separated into its various components through apheresis; buffy coat cells are thereafter treated with 8-methoxypsoralen before exposure to ultraviolet light and finally reinfused into the patient. There is a general agreement that this treatment has an anti-GVHD effect, but the mechanisms of action behind this effect are only partly understood. However, altered maturation of dendritic cells (DC) and thereby indirect modulation of T-cell reactivity seems to be one important mechanism together with DC-presentation of antigens derived from apoptotic donor T cells and induction of regulatory T cells. The treatment has been best studied in patients with chronic GVHD (both pediatric and adult patients), but most studies are not randomized and it is difficult to know whether the treatment is more effective than the alternatives. The clinical studies of ECP in adults with acute GVHD are few and not randomized; it is not possible to judge whether this treatment should be a preferred second- or third-line treatment. There is no evidence for increased risk of leukemia relapse or suppression of specific graft versus leukemia reactivity by this treatment, so specific antileukemic immunotherapy may still be possible. Thus, even though the treatment seems effective in patients with GVHD, further clinical (especially randomized) as well as biological studies with careful standardization of the treatment are needed before it is possible to conclude how ECP should be used in acute and chronic GVHD. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
03407004
Volume :
63
Issue :
8
Database :
Academic Search Index
Journal :
Cancer Immunology, Immunotherapy
Publication Type :
Academic Journal
Accession number :
97242035
Full Text :
https://doi.org/10.1007/s00262-014-1578-z