Transfusionsmedizin 2016; 6(03): 115-122
DOI: 10.1055/s-0042-110175
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Extrakorporale Photopherese

Extracorporeal Photopheresis
N. Worel
1   Univ. Klinik für Blutgruppenserologie und Transfusionsmedizin, Medizinische Universität Wien, Wien, Österreich
,
R. Knobler
2   Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
,
H. T. Greinix
3   Univ. Klinik für Innere Medizin, Klinische Abteilung für Hämatologie, Medizinische Universität Graz, Graz, Österreich
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
26. August 2016 (online)

Zusammenfassung

Bei der extrakorporalen Photopherese (ECP) handelt es sich um ein Therapiekonzept, das eine Leukapherese mit einer UVA-Lichtbestrahlung verbindet. Die durch Leukapherese gewonnenen kernhaltigen Zellen wie Lymphozyten und Monozyten werden nach Zugabe eines Photosensitizers (8-Methoxypsoralen) extrakorporal mit UVA-Licht bestrahlt werden. Für die Durchführung der ECP stehen unterschiedliche technische Geräte zur Verfügung. Bei Verwendung von geschlossenen (inline) Systemen werden die Zellsammlung und Bestrahlung ohne nötige Zwischenschritte mit demselben Equipment ausgeführt, wohingegen bei offenen (offline) Systemen die Zellsammlung mit einem konventionellen Blutzellseparator durchgeführt wird und die mit 8-Methoxypsoralen versetzten Zellen nach Überleiten in einen UVA-durchlässigen Beutel mit einer externen UVA-Licht-Quelle bestrahlt werden. Der therapeutische Effekt beruht auf einer Modulation des zellulären Immunsystems, wodurch es zu einer Abnahme der T-Zell-Aktivität kommt. Die ECP ist fixer Bestandteil in der Behandlung des kutanen T-Zell-Lymphoms, der akuten und chronischen Graft-versus-Host-Erkrankung nach allogener hämatopoietischer Stammzelltransplantation und der Behandlung von Abstoßungsepisoden nach Herz- und Lungentransplantation. Durch experimentelle wie auch klinische Untersuchungen zur Wirkung der ECP auf das Immunsystem kam es in den letzten Jahren zu einer Erweiterung des Indikationsspektrums wie zum Beispiel auf frühe Stadien der systemischen Sklerodermie (kutane Komponente). Die ECP ist eine sichere und effektive Behandlungsoption, die mit einer geringen Nebenwirkungsrate einhergeht.

Abstract

Extracorporeal photopheresis (ECP) combines a leukapheresis procedure with UVA irradiation where nucleated cells such as lymphocytes and monocytes undergo extracorporeal UVA irradiation after a photosensitizer (8-Methoxypsoralen) has been added. ECP can be performed using different technical devices. The closed (inline) system consists of an apheresis device with an incorporated UVA source. Cells are collected and irradiated without being discontinued from the patient. In contrast, open (offline) systems use a conventional blood cell separator for mononuclear cell collection and a separate UVA source for irradiation. The therapeutic effect of ECP is based on a modulation of the cellular immune system leading to a reduction in T-cell activity. ECP is an integral part in the treatment of cutaneous T-cell lymphoma, acute and chronic graft-versus-host disease after allogeneic stem cell transplantation, and rejection episodes after heart and lung transplantation. Due to recent findings in the mechanism of action on the immune system, indications for ECP have been expanded to treat a range of additional diseases such as early systemic sclerosis (cutaneous component). ECP is a safe and effective treatment modality and associated with few side effects.

 
  • Literatur

  • 1 Edelson R, Berger C, Gasparro F et al. Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. Preliminary results. N Engl J Med 1987; 316: 297-303
  • 2 Schwartz J, Winters JL, Padmanabhan A et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013; 28: 145-284
  • 3 Greinix HT, Socie G, Bacigalupo A et al. Assessing the potential role of photopheresis in hematopoietic stem cell transplant. Bone Marrow Transplant 2006; 38: 265-273
  • 4 McKenna KE, Whittaker S, Rhodes LE et al. British Photodermatology Group; UK Skin Lymphoma Group. Evidence-based practice of photopheresis 1987–2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group. Br J Dermatol 2006; 154: 7-20
  • 5 Jaksch P, Scheed A, Keplinger M et al. A prospective interventional study on the use of extracorporeal photopheresis in patients with bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant 2012; 31: 950-957
  • 6 Marques MB, Schwartz J. Update on extracorporeal photopheresis in heart and lung transplantation. J Clin Apher 2011; 26: 146-151
  • 7 Knobler RM, French LE, Kim Y et al. Systemic Sclerosis Study Group. A randomized, double-blind, placebo-controlled trial of photopheresis in systemic sclerosis. J Am Acad Dermatol 2006; 54: 793-799
  • 8 Adamski J, Kinard T, Ipe T et al. Extracorporeal photopheresis for the treatment of autoimmune diseases. Transfus Apher Sci 2015; 52: 171-182
  • 9 Fowler S, Jones J, Hull PR et al. Extracorporeal photopheresis for the treatment of Crohnʼs disease. Transfus Apher Sci 2015; 52: 183-186
  • 10 Hackstein H, Amoros JJ, Bein G et al. Successful use of miniphotopheresis for the treatment of graft-versus-host disease. Transfusion 2014; 54: 2022-2027
  • 11 Ivancic E, Knobler R, Quehenberger P et al. The course of anticoagulation after extracorporeal photochemotherapy. Photodermatol Photoimmunol Photomed 2005; 21: 150-151
  • 12 Greinix HT, Knobler RM, Worel N et al. The effect of intensified extracorporeal photochemotherapy on long-term survival in patients with severe acute graft-versus-host disease. Haematologica 2006; 91: 405-408
  • 13 Pavletic SZ, Martin P, Lee SJ et al. Response Criteria Working Group. Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report. Biol Blood Marrow Transplant 2006; 12: 252-266
  • 14 Barr ML, Meiser BM, Eisen HJ et al. Photopheresis for the prevention of rejection in cardiac transplantation. Photopheresis Transplantation Study Group. N Engl J Med 1998; 339: 1744-1751
  • 15 Morrell MR, Despotis GJ, Lublin DM et al. The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant 2010; 29: 424-431
  • 16 Just U, Knobler R. [Update on extracorporeal photopheresis]. Hautarzt 2015; 66: 804-809
  • 17 Gatza E, Rogers CE, Clouthier SG et al. Extracorporeal photopheresis reverses experimental graft-versus-host disease through regulatory T cells. Blood 2008; 112: 1515-1521
  • 18 Voss CY, Fry TJ, Coppes MJ et al. Extending the horizon for cell-based immunotherapy by understanding the mechanisms of action of photopheresis. Transfus Med Rev 2010; 24: 22-32
  • 19 Berger CL, Hanlon D, Kanada D et al. Transimmunization, a novel approach for tumor immunotherapy. Transfus Apher Sci 2002; 26: 205-216
  • 20 Fimiani M, Rubegni P, Pimpinelli N et al. Extracorporeal photochemotherapy induces a significant increase in CD36+ circulating monocytes in patients with mycosis fungoides. Dermatology 1997; 194: 107-110
  • 21 Yakut E, Jakobs C, Peric A et al. Extracorporeal photopheresis promotes IL-1beta production. J Immunol 2015; 194: 2569-2577
  • 22 Maeda A, Schwarz A, Kernebeck K et al. Intravenous infusion of syngeneic apoptotic cells by photopheresis induces antigen-specific regulatory T cells. J Immunol 2005; 174: 5968-5976
  • 23 Tiemessen MM, Mitchell TJ, Hendry L et al. Lack of suppressive CD4+CD25+FOXP3+ T cells in advanced stages of primary cutaneous T-cell lymphoma. J Invest Dermatol 2006; 126: 2217-2223
  • 24 Zhai Z, Sun Z, Li Q et al. Correlation of the CD4+CD25high T-regulatory cells in recipients and their corresponding donors to acute GVHD. Transpl Int 2007; 20: 440-446
  • 25 Kempf W, Pfaltz K, Vermeer MH et al. EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Blood 2011; 118: 4024-4035
  • 26 DallʼAmico R, Messina C. Extracorporeal photochemotherapy for the treatment of graft-versus-host disease. Ther Apher 2002; 6: 296-304
  • 27 Messina C, Locatelli F, Lanino E et al. Extracorporeal photochemotherapy for paediatric patients with graft-versus-host disease after haematopoietic stem cell transplantation. Br J Haematol 2003; 122: 118-127
  • 28 Jagasia M, Greinix H, Robin M et al. Extracorporeal photopheresis versus anticytokine therapy as a second-line treatment for steroid-refractory acute GVHD: a multicenter comparative analysis. Biol Blood Marrow Transplant 2013; 19: 1129-1133
  • 29 Benden C, Speich R, Hofbauer GF et al. Extracorporeal photopheresis after lung transplantation: a 10-year single-center experience. Transplantation 2008; 86: 1625-1627
  • 30 Urbani L, Mazzoni A, Colombatto P et al. A novel immunosuppressive strategy combined with preemptive antiviral therapy improves the eighteen-month mortality in HCV recipients transplanted with aged livers. Transplantation 2008; 86: 1666-1671
  • 31 DallʼAmico R, Murer L, Montini G et al. Successful treatment of recurrent rejection in renal transplant patients with photopheresis. J Am Soc Nephrol 1998; 9: 121-127
  • 32 Di Spaltro FX, Cottrill C, Cahill C et al. Extracorporeal photochemotherapy in progressive systemic sclerosis. Int J Dermatol 1993; 32: 417-421
  • 33 Schwartz J, Gonzalez J, Palangio M et al. Extracorporeal photochemotherapy in progressive systemic sclerosis: a follow-up study. Int J Dermatol 1997; 36: 380-385
  • 34 Rook AH, Freundlich B, Jegasothy BV et al. Treatment of systemic sclerosis with extracorporeal photochemotherapy. Results of a multicenter trial. Arch Dermatol 1992; 128: 337-346
  • 35 Guariso G, DʼInca R, Sturniolo GC et al. Photopheresis treatment in severe Crohn disease. J Pediatr Gastroenterol Nutr 2003; 37: 517-520
  • 36 Reinisch W, Nahavandi H, Santella R et al. Extracorporeal photochemotherapy in patients with steroid-dependent Crohnʼs disease: a prospective pilot study. Aliment Pharmacol Ther 2001; 15: 1313-1322
  • 37 Abreu MT, von Tirpitz C, Hardi R et al. Crohnʼs Disease Photopheresis Study Group. Extracorporeal photopheresis for the treatment of refractory Crohnʼs disease: results of an open-label pilot study. Inflamm Bowel Dis 2009; 15: 829-836
  • 38 Reinisch W, Knobler R, Rutgeerts PJ et al. Extracorporeal photopheresis (ECP) in patients with steroid-dependent Crohnʼs disease: an open-label, multicenter, prospective trial. Inflamm Bowel Dis 2013; 19: 293-300
  • 39 Knobler R, Barr ML, Couriel DR et al. Extracorporeal photopheresis: past, present, and future. J Am Acad Dermatol 2009; 61: 652-665
  • 40 Gollnick HP, Owsianowski M, Taube KM et al. Unresponsive severe generalized pemphigus vulgaris successfully controlled by extracorporeal photopheresis. J Am Acad Dermatol 1993; 28: 122-124
  • 41 Ward DM. Extracorporeal photopheresis: how, when, and why. J Clin Apher 2011; 26: 276-285