Photopheresis

Not to be confused with photophoresis.
Photopheresis
Intervention
ICD-10-PCS [note 1]
ICD-9 99.88
MeSH D017893

In medicine, photopheresis (aka extracorporeal photopheresis or ECP)[1] is a form of apheresis and photodynamic therapy in which blood is treated with a photosensitizing agent and subsequently irradiated with specified wavelengths of light to achieve an effect. Specifically, buffy coat (WBC + platelets) is separated from whole blood, chemically treated with 8-methoxypsoralen (instilled into collection bag or given per os in advance), exposed to ultraviolet light (UVA), and returned to the patient.[2] Activated 8-methoxypsoralen crosslinks DNA in exposed cells, ultimately resulting apoptosis of nucleated cells.[1] The photochemically damaged T-cells returned to the patient appear to induce cytotoxic effects on T-cell formation. The mechanism of such “antitumor” action has not been elucidated.

Photopheresis involving 8-methoxypsoralen was first described in a 1987 New England Journal of Medicine publication.[1][3] Photopheresis is currently standard therapy approved by the U.S. Food and Drug Administration (FDA) for cutaneous T-cell lymphoma. Evidence suggests that this treatment might be effective in the treatment of graft-versus-host disease, though this evidence is largely observational and controlled trials are needed to support this use.[1][supp 1][supp 2] Photopheresis has also been used successfully in the treatment of epidermolysis bullosa acquisita when all other treatments have been ineffective.[4]

Minimal observed side effects for patients receiving photopheresis include hypotension and syncope resulting from volume shifts during leukapheresis phase of treatment. Photopheresis is also used as an experimental treatment in patients with cardiac, pulmonary and renal allograft rejection, graft-versus-host disease, autoimmune diseases, nephrogenic systemic fibrosis and ulcerative colitis.

See also

References

  1. 1 2 3 4 Klassen, J (2010). "The role of photopheresis in the treatment of graft-versus-host disease". Current oncology (Toronto, Ont.). 17 (2): 55–8. PMC 2854639Freely accessible. PMID 20404979.
  2. ↑ "National Coverage Determination (NCD) for Extracorporeal Photopheresis (110.4)". Medicare Coverage Database. Centers for Medicare and Medicaid Services. 30 April 2012. Item/Service Description. 100-3.
  3. ↑ Edelson, R; Berger, C; Gasparro, F; Jegasothy, B; Heald, P; Wintroub, B; Vonderheid, E; Knobler, R; Wolff, K; Plewig, G; McKiernan, Glynis; Christiansen, Inger; Oster, Martin; Honigsmann, Hubert; Wilford, Hubert; Kokoschka, Eva; Rehle, Thomas; Perez, Maritza; Stingl, George; Laroche, Liliane (1987). "Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. Preliminary results". New England Journal of Medicine. 316 (6): 297–303. doi:10.1056/NEJM198702053160603. PMID 3543674.
  4. ↑ Gupta, R; Woodley, D. T.; Chen, M (2012). "Epidermolysis bullosa acquisita". Clinics in Dermatology. 30 (1): 60–9. doi:10.1016/j.clindermatol.2011.03.011. PMC 3234994Freely accessible. PMID 22137228.

Supplemental references

  1. ↑ Weitz, M; Strahm, B; Meerpohl, J. J.; Bassler, D (2014). "Extracorporeal photopheresis versus alternative treatment for chronic graft-versus-host disease after haematopoietic stem cell transplantation in paediatric patients". The Cochrane Library. 2: CD009898. doi:10.1002/14651858.CD009898.pub2. PMID 24569961.
  2. ↑ Weitz, M; Strahm, B; Meerpohl, J. J.; Bassler, D (2014). "Extracorporeal photopheresis versus standard treatment for acute graft-versus-host disease after haematopoietic stem cell transplantation in paediatric patients". The Cochrane Library. 2: CD009759. doi:10.1002/14651858.CD009759.pub2. PMID 24569960.

3. Maceira Rozas MC. Fotoaféresis para pacientes con enfermedad de injerto contra huésped resistente a esteroides. Santiago de Compostela: Axencia de Avaliación de Tecnoloxías Sanitarias de Galicia, avalia-t; 2014. Available from: http://www.sergas.es/docs/Avalia-t/electroporacion/CT201402Fotoafereis_Def.pdf

Notes

  1. ↑ ICD10 Procedure code: this was assigned based on cross-walking from the ICD9 code at ICD10DAta.com
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