Extracorporeal photochemoimmunotherapy in cutaneous T-cell lymphoma
Abstract
Extracorporeal photochemotherapy was originally conceived for the treatment of cutaneous T-cell lymphoma (CTCL) and as well as other T-cell mediated diseases. Evidence collected in the past 17 years has demonstrated that this treatment modality can have a very significant effect on the course of a subset of CTCL patients. The evidence available is positive but for a variety of reasons has been controversial within the medical community. A number of very well-designed multi-center trials which have been lacking since the first publication by Edelson et al. are being carried out so that hopefully a number of open questions will be resolved with greater clarity in the coming years. The fact remains that this innovative approach for the treatment of CTCL and T-cell mediated diseases has certainly opened new avenues of therapy and thought in photoimmunology and photomedicine. Clearly the very low side effect profile of this therapy has made it more attractive than the chemotherapeutic and immunosuppressive substances that are presently available or in experimental protocols. If and when the mechanisms of action are fully understood and appropriate studies investigating different treatment schedules and different combination therapies and modifications of its present form are performed the place of photopheresis in the therapeutics of CTCL as well as other T-cell mediated diseases and oncology will be better placed.
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Psoralen derivatives are used in photopheresis of cutaneous T-cell lymphoma and photoinactivation of pathogens in plasma and platelet components.
“Other applications of psoralen derivatives deal with the photopheresis of cutaneous T-cell lymphoma (156-158) and the photoinactivation of pathogens in plasma and platelet components (159,160).”
From Photoinduced Damage to Cellular DNA: Direct and Photosensitized Reactions<sup>†</sup> (2012) · cites this paper as [156]
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Miller, J. D., Kirkland, E. B., Domingo, D. S., Scull, H., Jekutis, B., Dallas, M., Cooper, K. D., & Baron, E. D. (2007) · Photodermatology Photoimmunology & Photomedicine · doi:10.1111/j.1600-0781.2007.00300.x · Cited by 38 · see citing works
“In part, a lack of universal acceptance of standardized elements of classification and diagnosis of CTCL compromise planning such clinical trials (2, 22).”
BackgroundResultPhotopheresis (extracorporeal photochemotherapy)
Trautinger, F., Just, U., & Knobler, R. (2012) · Photochemical & Photobiological Sciences · doi:10.1039/c2pp25144b · Cited by 36 · see citing works
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“Discussion So far, about 800 ECP procedures have been performed in our institution, mostly in patients who had undergone either bone marrow or haematopoietic stem cell transplantation and who developed GVHD unresponsive to standard treatment.”
BackgroundInfluentialBisaccia, E., Vonderheid, E. C., & Geskin, L. J. (2009) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2009.09081.x · Cited by 34 · see citing works
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Emerging role of epigenetic therapies in cutaneous T-cell lymphomas
Zain, J. M., Kaminetzky, D., & O’Connor, O. A. (2010) · Expert Review of Hematology · doi:10.1586/ehm.10.9 · Cited by 28 · see citing works
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“CTCL patients underwent ECP on 2 consecutive days once a month (1-4); GvHD patients were treated on 2 consecutive days every week for the first month, then every 2 weeks for 2-3 months, thereafter monthly (5-6).”
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“In addition, patients without profound immune deficiencies, reflected by normal or near-normal cytotoxic T-cell and CD4/CD8 values and the absence of prior exposure to systemic chemotherapy, may be more likely to respond to therapy [306, 308, 314].”
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“Indeed, there is considerable evidence that ECP do not result in immunesuppression, since no increase in infectious episodes has been observed in hundreds of treated patients [34–36].”
BackgroundWhat's new in the management of cutaneous T-cell lymphoma?
McFarlane, V., Friedmann, P. S., & Illidge, T. (2005) · Clinical Oncology · doi:10.1016/j.clon.2004.11.010 · Cited by 15 · see citing works
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“Although overall response rates in MF/SS are approximately 63% [80], response rates are highest in those with erythrodermic MF and SS [78,81,82].”
BackgroundCutaneous T-Cell Lymphomas: A Review of New Discoveries and Treatments
Bloom, T., Kuzel, T. M., Querfeld, C., Guitart, J., & Rosen, S. T. (2012) · Current Treatment Options in Oncology · doi:10.1007/s11864-011-0179-8 · Cited by 10 · see citing works
Topuzoglu, S., Knobler, R., Movadat, O., Petkov, V., Foedinger, D., Just, U., Pehamberger, H., & Jantschitsch, C. (2014) · Photodermatology Photoimmunology & Photomedicine · doi:10.1111/phpp.12155 · Cited by 8 · see citing works
“ECP is an FDA-approved therapy of advanced stage cutaneous T-cell lymphoma (7).”
BackgroundSelf-citationTreatment of Cutaneous Lymphomas: Today and Tomorrow
Mestel, D. S., Beyer, M., Steinhoff, M., & Sterry, W. (2009) · Actas Dermo-Sifiliográficas · doi:10.1016/s0001-7310(09)73165-5 · Cited by 6 · see citing works
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Pediatric Therapeutic Apheresis
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Fotoféresis: nueva terapia inmunomoduladora para enfermedades mediadas por linfocitos T
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Mycosis Fungoides and S ézary Syndrome
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Therapeutic Apheresis in Children
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Light Therapies for Cutaneous T-Cell Lymphoma
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- Authors
- Knobler, R., & Jantschitsch, C.
- Affiliations
- University of Vienna (AT)
- Corresponding author
- Knobler, R.
- Venue
- Transfusion and Apheresis Science
- Publisher
- Elsevier BV
- Published
- 2003-02
- Volume
- 28
- Issue
- 1
- Pages
- 81-89
- ISSN
- 1473-0502 (ISSN-L)
- OpenAlex
- W2115597921
- Cited by
- 61
- References
- 61
- Citations by year
- 2025: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 6 · 2013: 4 · 2012: 4
- FWCI
- 0.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transfusion and Apheresis Science (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Cutaneous lymphoproliferative disorders research
- Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
- Health Sciences › Medicine › Dermatology › Skin Protection and Aging
- Keywords
- extracorporeal photopheresis, cutaneous T-cell lymphoma, T cell-mediated disease, photoimmunology, photomedicine, therapeutic mechanisms, combination therapy, treatment schedule, adverse effects
- MeSH terms
- Combined Modality Therapy, Humans, Immunity, Cellular, Immunotherapy, Sezary Syndrome, Cytokines, Lymphoma, T-Cell, Cutaneous, Photopheresis
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