Evidence-based practice of photopheresis 1987-2001: A report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group

K. E. McKenna, S. Whittaker, L. E. Rhodes, P. Taylor, J. Lloyd, S. Ibbotson, R. Russell-Jones

    Research output: Contribution to journalArticle

    85 Citations (Scopus)

    Abstract

    Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy which involves separation of the patient's leucocyte-rich plasma, followed by ex vivo administration of a photosensitizer and ultraviolet A radiation, before reinfusion. ECP has been used successfully for the treatment of cutaneous T-cell lymphoma (CTCL: Sézary syndrome), graft-versus-host disease (GVHD) and cardiac transplant rejection. ECP has a dose-sparing effect on concurrent immunosuppressive therapy. The procedure induces apoptosis of the irradiated lymphocytes, but the exact mechanism by which ECP exerts its therapeutic effect in these different conditions is uncertain. The treatment has very few adverse effects and in particular is not associated with an increased incidence of opportunistic infections. The evidence for the efficacy of ECP has been appraised by a combined British Photodermatology Group and U.K. Skin Lymphoma Group workshop on the basis of evidence published up to the end of 2001 and on the consensus of best practice. There is fair evidence for the use of ECP in erythrodermic CTCL and steroid-refractory GVHD, but randomized controlled studies are needed. There is good evidence supporting the use of ECP in preventing cardiac rejection following transplantation. Randomized controlled trials have also shown a therapeutic benefit in type 1 diabetes mellitus, but the inconvenience associated with the procedure outweighed the clinical benefit. There is fair evidence not to use ECP for the treatment of systemic sclerosis and multiple sclerosis, and good evidence not to use ECP for other forms of CTCL.

    Original languageEnglish
    Pages (from-to)7-20
    Number of pages14
    JournalBritish Journal of Dermatology
    Volume154
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2006

    Fingerprint

    Photopheresis
    Evidence-Based Practice
    Lymphoma
    Education
    Skin
    Graft Rejection
    Graft vs Host Disease
    Therapeutics
    Cutaneous T-Cell Lymphoma
    Photosensitizing Agents
    Immunomodulation
    Systemic Scleroderma
    Opportunistic Infections
    Therapeutic Uses
    Immunosuppressive Agents
    Type 1 Diabetes Mellitus
    Practice Guidelines
    Multiple Sclerosis
    Leukocytes
    Randomized Controlled Trials

    Keywords

    • Cardiac transplant rejection
    • Cutaneous T-cell lymphoma
    • Extracorporeal photochemotherapy
    • Graft-versus-host disease
    • Sézary syndrome

    Cite this

    McKenna, K. E. ; Whittaker, S. ; Rhodes, L. E. ; Taylor, P. ; Lloyd, J. ; Ibbotson, S. ; Russell-Jones, R. / Evidence-based practice of photopheresis 1987-2001 : A report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group. In: British Journal of Dermatology. 2006 ; Vol. 154, No. 1. pp. 7-20.
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    abstract = "Photopheresis or extracorporeal photochemotherapy (ECP) is a novel immunomodulatory therapy which involves separation of the patient's leucocyte-rich plasma, followed by ex vivo administration of a photosensitizer and ultraviolet A radiation, before reinfusion. ECP has been used successfully for the treatment of cutaneous T-cell lymphoma (CTCL: S{\'e}zary syndrome), graft-versus-host disease (GVHD) and cardiac transplant rejection. ECP has a dose-sparing effect on concurrent immunosuppressive therapy. The procedure induces apoptosis of the irradiated lymphocytes, but the exact mechanism by which ECP exerts its therapeutic effect in these different conditions is uncertain. The treatment has very few adverse effects and in particular is not associated with an increased incidence of opportunistic infections. The evidence for the efficacy of ECP has been appraised by a combined British Photodermatology Group and U.K. Skin Lymphoma Group workshop on the basis of evidence published up to the end of 2001 and on the consensus of best practice. There is fair evidence for the use of ECP in erythrodermic CTCL and steroid-refractory GVHD, but randomized controlled studies are needed. There is good evidence supporting the use of ECP in preventing cardiac rejection following transplantation. Randomized controlled trials have also shown a therapeutic benefit in type 1 diabetes mellitus, but the inconvenience associated with the procedure outweighed the clinical benefit. There is fair evidence not to use ECP for the treatment of systemic sclerosis and multiple sclerosis, and good evidence not to use ECP for other forms of CTCL.",
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    Evidence-based practice of photopheresis 1987-2001 : A report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group. / McKenna, K. E.; Whittaker, S.; Rhodes, L. E.; Taylor, P.; Lloyd, J.; Ibbotson, S.; Russell-Jones, R.

    In: British Journal of Dermatology, Vol. 154, No. 1, 01.01.2006, p. 7-20.

    Research output: Contribution to journalArticle

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