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Extracorporeal photopheresis

Sila Seremet, Sunil Abhyankar, Tiffany J Herd, Daniel Aires
INTRODUCTION: Extracorporeal photopheresis (ECP) has been used for the treatment of advanced stage or treatment refractory cutaneous T-cell lymphoma (CTCL) since 1987, and more recently has also been shown to be of benefit for earlier stage resistant CTCL. Complete response rates in prior studies of ECP in early CTCL have ranged from 0% to 40%. METHODS: We reviewed electronic medical records of all CTCL patients seen in the University of Kansas Cancer Center between June 2007 and May 2011...
October 1, 2016: Journal of Drugs in Dermatology: JDD
Britt Van Aelst, Rosalie Devloo, Pierre Zach Eacutee, Ruben t'Kindt, Koen Sandra, Philippe Vandekerckhove, Veerle Compernolle, Hendrik B Feys
Psoralen and ultraviolet A light (PUVA) is used to kill pathogens in blood products and as a treatment of aberrant cell proliferation in dermatitis, cutaneous T-cell lymphoma and graft-versus-host-disease (GVHD). DNA damage is well described, but the direct effects of PUVA on cell signal transduction are poorly understood. Because platelets are anucleate and contain archetypal signal transduction machinery these are ideally suited to address this. Lipidomics on platelet membrane extracts showed that psoralen forms adducts with unsaturated carbon bonds of fatty acyls in all major phospholipid classes after PUVA...
September 29, 2016: Journal of Biological Chemistry
C Pochon, L Reppel, P Halle, A Zang, L Clément, D Michel, A Perrot, G Roth-Guépin, M Detrait, J Kanold, N Rouel, B Donzé, V Décot, S Mathieu-Nafissi, E Merlin, D Bensoussan
No abstract text is available yet for this article.
September 19, 2016: Bone Marrow Transplantation
Cherie Rushton, Leeah Robertson, Tracie Taylor, Peter Taylor, Paul Button, Arun Alfred
The photopheresis unit where the authors work has seen an increased demand both locally and as an outreach service. A Lean assessment of the unit was undertaken to improve processing time and productivity, which in turn would improve the availability of treatment and improve patient care. The assessment indicated that there were excellent nursing standards and patient care; however, patient waiting times and treatment times were prolonged in comparison with other units. The unit reviewed the patient pathway and identified where delays occurred and consequently changed patient scheduling...
September 8, 2016: British Journal of Nursing: BJN
Vedat Uygun, Hayriye Daloğlu, Seda Irmak Öztürkmen, Levent Döşemeci, Gülsün Karasu, Volkan Hazar, Akif Yeşilipek
BACKGROUND: Myasthenia gravis (MG) is a neuromuscular disorder characterized by an autoimmune defect in the neuromuscular junction. In most patients, the autoimmune attack is mediated by antibodies against the acetylcholine receptor (AChR) on the postsynaptic membrane. Deficient immunoregulation, including regulatory T cells, is consistently observed. Extracorporeal photopheresis (ECP) leads to the induction of regulatory T cells that mediate immunologic tolerance in autoimmune diseases; however, the data regarding MG are very limited...
September 9, 2016: Transfusion
Michele Malagola, Valeria Cancelli, Cristina Skert, Pierino Ferremi Leali, Emilio Ferrari, Alessandra Tiburzi, Maria Luisa Sala, Irene Donnini, Patrizia Chiusolo, Alberto Muffetti, Marta Battista, Alessandro Turra, Federica Cattina, Benedetta Rambaldi, Francesca Schieppati, Nicola Polverelli, Simona Bernardi, Simone Perucca, Mirella Marini, Daniele Laszlo, Chiara Savignano, Francesca Patriarca, Paolo Corradini, Nicola Piccirillo, Simona Sica, Alberto Bosi, Domenico Russo
BACKGROUND: Extracorporeal photopheresis (ECP) is considered a valid second-line treatment for acute and chronic graft versus host disease (GVHD). METHODS: Ninety-four patients with aGVHD (n=45) and cGVHD (n=49), retrospectively recruited in 6 Italian Centers, were submitted to ECP for second-line treatment. At the time of ECP, 22 (49%) and 23 (51%) out of 45 patients with aGHVD were non responsive (NR) and in partial remission (PR) after steroids, respectively, and all the 49 patients with cGVHD were steroid refractory...
September 8, 2016: Transplantation
Mark Oldham, Paul Yoon, Zak Fathi, Wayne F Beyer, Justus Adamson, Leihua Liu, David Alcorta, Wenle Xia, Takuya Osada, Congxiao Liu, Xiao Y Yang, Rebecca D Dodd, James E Herndon, Boyu Meng, David G Kirsch, H Kim Lyerly, Mark W Dewhirst, Peter Fecci, Harold Walder, Neil L Spector
This work investigates X-PACT (X-ray Psoralen Activated Cancer Therapy): a new approach for the treatment of solid cancer. X-PACT utilizes psoralen, a potent anti-cancer therapeutic with current application to proliferative disease and extracorporeal photopheresis (ECP) of cutaneous T Cell Lymphoma. An immunogenic role for light-activated psoralen has been reported, contributing to long-term clinical responses. Psoralen therapies have to-date been limited to superficial or extracorporeal scenarios due to the requirement for psoralen activation by UVA light, which has limited penetration in tissue...
2016: PloS One
V Becherucci, E Allegro, F Brugnolo, L Piccini, V Gori, S Bisin, B Bindi, R Ceccantini, P Pavan, V Cunial, F Gentile, S Ermini, F Bambi
The GvHD is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal photopheresis (ECP) represents an alternative therapeutic strategy to immunosuppressive therapy. Although ECP is used since 1990s, the mechanism of action has not yet been completely clarified. We analyzed cells collected from 20 ECP procedures of 4 patients affected by chronic GvHD and, for comparison, Peripheral Blood Mononuclear Cells (PBMCs) of 10 healthy donors undergoing from same type of photochemiotherapy, evaluating by flow cytometry, the effects before and after photoactivation with 8-MOP...
July 31, 2016: Journal of Clinical Apheresis
Andreas Brosig, Viola Hähnel, Evelyn Orsó, Daniel Wolff, Ernst Holler, Norbert Ahrens
BACKGROUND: Extracorporeal photopheresis (ECP) is a therapeutic technique that combines leukapheresis and ultraviolet (UV)A irradiation of the leukapheresate after 8-methoxypsoralen treatment with subsequent retransfusion. It can be achieved with a single device (online) or by combining an apheresis machine with a separate UVA light source (offline). The comparability of both established methods is unknown. STUDY DESIGN AND METHODS: In a prospective setting, four ECP systems were evaluated: one with integrated UVA irradiation for online ECP (Therakos) and three with external UVA irradiation for offline ECP (Amicus, Optia, and Cobe Spectra)...
October 2016: Transfusion
Nancy M Dunbar, Jay S Raval, Andrew Johnson, Cori M Abikoff, Jill Adamski, Laura L Cooling, Brenda Grossman, Haewon C Kim, Marisa B Marques, Shanna Morgan, Amy E Schmidt, Steven R Sloan, Leon L Su, Zbigniew M Szczepiorkowski, F Bernadette West, Edward Wong, Jennifer Schneiderman
BACKGROUND: Although many apheresis centers offer extracorporeal photopheresis (ECP), little is known about current treatment practices. METHODS: An electronic survey was distributed to assess ECP practice internationally. RESULTS: Of 251 responses, 137 met criteria for analysis. Most respondents were from North America (80%). Nurses perform ECP at most centers (84%) and the majority of centers treat adults only (52%). Most centers treat fewer than 50 patients/year (83%) and perform fewer than 300 procedures/year (70%)...
July 21, 2016: Journal of Clinical Apheresis
D Miguel, J Lukacs, T Illing, P Elsner
Necrobiotic xanthogranuloma (NXG) is an uncommon non-Langerhans cell histiocytosis involving skin and extracutaneous tissues. The lesions are usually asymptomatic and commonly appear in the periorbital area. Paraproteinemia is closely associated with NXG and its pathogenesis remains unclear. NXG prognosis is poor with several treatments showing variable results. Treatment of monoclonal gammopathy with alkylating agents does not necessarily influence the activity of the skin disease and vice versa. The aim of this systematic review is to summarize all reported treatments of necrobiotic xanthogranuloma of the skin, with or without underlying malignant condition and based on articles from the PubMed database using the query 'necrobiotic xanthogranuloma treatment', both in English and German, about 'human' subjects and published between 1980 and 2014, documenting adequate treatment for NXG...
July 19, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
Aisling M Flinn, Andrew R Gennery
Acute graft-versus-host disease (aGvHD) continues to be a major obstacle to allogeneic haematopoietic stem cell transplantation. Thymic damage secondary to aGvHD along with corticosteroids and other non-selective T lymphocyte-suppressive agents used in the treatment of aGvHD concurrently impair thymopoiesis and negatively impact on immunoreconstitution of the adaptive immune compartment and ultimately adversely affect clinical outcome. Extracorporeal photopheresis (ECP) is an alternative therapeutic strategy that appears to act in an immunomodulatory fashion, potentially involving regulatory T lymphocytes and dendritic cells...
2016: F1000Research
N Kibbi, O Sobolev, M Girardi, R L Edelson
Extracorporeal photochemotherapy (ECP), or photopheresis, is distinguished by the specificity of the clinically potent immunologic reactions it initiates or regulates. The selectivity of ECP-induced immunoprotection for the malignant clone in cutaneous T cell lymphoma (CTCL), and for the pathogenic clones in allograft rejection and graft-versus-host disease (GVHD), has suggested a central mechanistic role for dendritic antigen presenting cells (DC). Discovery of ECP's induction of monocyte-derived DC, via monocyte signaling by ECP-plate activated platelets, and the absolute dependency of experimental ECP on such induced DC, supports that premise...
August 2016: Transfusion and Apheresis Science
Zachariah A McIver, Mark W Kryman, Young Choi, Benjamin N Coe, Gregory A Schamerhorn, Michelle K Linder, Kellie S Davies, Jacqueline E Hill, Geri A Sawada, Jason M Grayson, Michael R Detty
Extracorporeal photopheresis (ECP) has been used successfully in the treatment of erythrodermic cutaneous T cell lymphoma (CTCL), and other T cell-mediated disorders. Not all patients obtain a significant or durable response from ECP. The design of a selective photosensitizer that spares desirable lymphocytes while targeting malignant T cells may promote cytotoxic T cell responses and improve outcomes after ECP. A series of selenorhodamines built with variations of the Texas red core targeted the mitochondria of malignant T cells, were phototoxic to malignant T cells presumably via their ability to generate singlet oxygen, and were transported by P-glycoprotein (P-gp)...
September 1, 2016: Bioorganic & Medicinal Chemistry
Claudia Del Fante, Luigia Scudeller, Alberto Martinasso, Gianluca Viarengo, Cesare Perotti
BACKGROUND: Extracorporeal photopheresis (ECP) is an effective cell therapy employed in several diseases, including graft versus host disease (GVHD) and organ rejection. When ECP is performed using an off-line technique, mononuclear cell (MNC) collection by leukapheresis is necessary for further manipulation (addition of 8-methoxypsoralen and ultraviolet A irradiation before reinfusion to the patient). We report the results of the first crossover equivalence study on yield and purity of MNCs collected from patients undergoing ECP with two different automated systems: MNC and CMNC (working with intermittent and continuous-flow collection, respectively), released by Terumo BCT...
August 2016: Transfusion
Sean Whittaker, Richard Hoppe, H Miles Prince
Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma variant and is closely related to a rare leukemic variant, Sézary syndrome (SS). MF patients at risk of disease progression can now be identified and an international consortium has been established to address the prognostic relevance of specific biologic factors and define a prognostic index. There are a lack of randomized clinical trial data in MF/SS and evidence is based on a traditional "stage-based" approach; treatment of early-stage disease (IA-IIA) involves skin directed therapies which include topical corticosteroids, phototherapy (psoralen with UVA or UVB), topical chemotherapy, topical bexarotene, and radiotherapy including total skin electron beam therapy...
June 23, 2016: Blood
Helen A Denney, Robert J Whittle, Jennifer Lai, Richard M Jacques, Peter C Taylor
BACKGROUND: Induction of immune tolerance by an increase in regulatory T (Treg) cells after extracorporeal photopheresis (ECP) is thought to contribute to how ECP exerts its therapeutic effect in patients with chronic graft-versus-host disease (cGvHD). We investigated whether percentages and absolute counts of Treg cells changed post-ECP, and examined correlation with response. METHODS: Absolute counts and % of CD4+ T cells and Treg cells (CD4 + CD25 + FOXP3 + CD127dim/-) were evaluated using flow cytometry in 32 patients with cGvHD treated by ECP for a minimum of 3 months, and up to 12 months...
March 22, 2016: Transplantation
Joerg Bittenbring, Joerg Reichrath
Graft versus host disease (GvHD) is one of the most feared adverse events of allogeneic hematopoietic stem cell transplantation. In severe grades of GvHD patients die from infections due to impairment of their immune defense or therapy-refractory involvement of intestines, liver and lung. Extracorporeal photopheresis is an effective treatment for acute and chronic graft versus host disease without severe impairment of the recipient's immune system. It is generally better known for its effect on skin GvHD but all other manifestations of GvHD can respond as well...
March 2016: Anticancer Research
Christoph Grabmer, Sandra Schlager, Georg Mayer, Doris Streif, Thomas Lener, Katharina Schallmoser, Eva Rohde
BACKGROUND: Extracorporeal photopheresis (ECP) is an important cell-based therapy for various diseases but is limited to patients eligible for apheresis. We developed an alternative mini buffy coat (BC) preparation method using the Spectra Optia® apheresis system and compared its efficacy of white blood cell (WBC) recovery with the standard mini BC preparation method already established for pediatric patients. METHODS: Whole blood (450 ± 45 mL) samples were collected from 30 randomly selected healthy volunteer blood donors and divided into two groups...
March 4, 2016: Journal of Clinical Apheresis
Ximing Wu, Xiaoqing Hu, Michael R Hamblin
Ultraviolet blood irradiation (UBI) was extensively used in the 1940s and 1950s to treat many diseases including septicemia, pneumonia, tuberculosis, arthritis, asthma, and even poliomyelitis. The early studies were carried out by several physicians in USA and published in the American Journal of Surgery. However, with the development of antibiotics, the use of UBI declined and it has now been called "the cure that time forgot." Later studies were mostly performed by Russian workers, and in other Eastern countries, and the modern view in Western countries is that UBI remains highly controversial...
April 2016: Journal of Photochemistry and Photobiology. B, Biology
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