LEBANON, NH — Extracorporeal photopheresis (ECP) is a leukapheresis-based therapeutic procedure that has been approved by the Food and Drug Administration (FDA) for the treatment of advanced cutaneous T-cell lymphoma (CTCL) since 1988.
In ECP, white blood cells are collected and exposed to a photosensitizer, 8-methoxypsoralen (8-MOP), and ultraviolet A (UVA) radiation. UVA activates 8-MOP and causes crosslinkage of DNA. Performed via intravenous access, the procedure has three stages: (1) leukapheresis, (2) photoactivation, and (3) reinfusion of treated cell product back to the patient.
ECP, also known as extracorporeal photochemotherapy and extracorporeal photoimmunotherapy, is performed at over 200 centers worldwide. A study in the Journal of Clinical Apheresis pointed out, however, that although many apheresis centers offer ECP, little is known about current treatment practices.1
A study team led by Dartmouth-Hitchcock Medical Center researchers and including participation from the Minneapolis VAMC sought to remedy that by distributing an electronic survey to assess ECP practice internationally.
Of 251 responses, 137 met criteria for analysis. The article reports that most, 80%, of respondents were from North America. Survey responses indicated that nurses perform ECP at most centers (84%) and the majority of centers treat adults only (52%). In addition, most centers treat fewer than 50 patients/year (83%) and perform fewer than 300 procedures/year (70%).
Closed system devices (XTS and/or Cellex) are used to perform ECP at nearly all centers, 96%. Closed systems integrate drug photoactivation and reinfusion, thus lowering risk of infection, contamination, and errors during reinfusion.
The most common indications for ECP are acute/chronic skin graft versus host disease (89%) and CTCL (63%), with a typical wait time of less than two weeks. Most centers, 66%, reported that they do not routinely perform quality control assessment of the collected product.
The report also discussed device-specific differences in treatment parameters. “For example, XTS users more frequently have a minimum weight limit (P = 0.003) and use laboratory parameters to determine eligibility for treatment (P = 0.03),” study authors wrote. “Regardless of device used, the majority of centers assess the clinical status of the patient before each procedure.” They noted that more than 50% of respondents said they would defer treatment for hemodynamic instability due to active sepsis or heart failure, positive blood culture in the past 24 hours or current fever.
“This survey based study describes current ECP practices. Further research to provide evidence for optimal standardization of patient qualifications, procedure parameters and product quality assessment is recommended,” the researchers add.
In addition to CTCL and graft versus host disease, ECP has been shown to have efficacy in the treatment of solid organ transplant rejection, scleroderma, atopic dermatitis, epidermolysis bullosa acquisita, lichen planus, lupus erythematosus, pemphigus vulgaris, Crohn disease, and type 1 diabetes. Some researcher has suggested value of extracorporeal photopheresis in the treatment of psoriasis, rheumatoid arthritis, multiple sclerosis, nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy, and scleromyxedema.
- Dunbar NM, Raval JS, Johnson A, Abikoff CM, et. al. Extracorporeal photopheresis practice patterns: An international survey by the ASFA ECP subcommittee. J Clin Apher. 2017 Aug;32(4):215-223. doi: 10.1002/jca.21486. Epub 2016 Jul 21. PubMed PMID: 27442906.
