Extra corporeal photo chemotherapy (ECP) in acute and chronic GVHD

Abstract

Allogeneic hematopoietic stem cell transplantation (HCT) is frequently complicated by graft-versus-host disease (GVHD). The severity and frequency of GvHD depends on many factors such as age and gender of donor and patient, HLA compatibility, peripheral blood or bone marrow or cord blood stem cell origin and its dose, conditioning and prophylactic regimens. The acute GvHD (aGvHD) occurs in about 80% of unrelated donor transplants [1] and 60% of HLA-identical ones [2] and chronic GvHD (cGvHD) occurs in approximately 50% of the patients [3] despite immunosuppressive therapies. Extra corporeal photo chemotherapy (ECP) or photopheresis is an immunomodulating cell therapy in which the own mononuclear cells of the patient are reinjected to him after ex vivo exposure to UVA light in the presence of a DNA intercaling agent, 8-methoxy psoralene (8-MOP). This therapy was first used successfully in the treatment of cutaneous T-cell lymphoma (CTCL) [4], and then in a variety of T-cell depending pathologies including GvHD. Due to the efficacy and safety of ECP, the number of treatedpatients increaseddramatically in the world in three main indications: GvHD, CTCL and Acute graft rejection. The other indications of ECP are: autoimmune diseases (rheumatoid arthritis, systemic sclerosis, SEL, pemphigus vulgaris, multiple sclerosis, erosive lichen planus, generalized extensive lichen planus, diabetes, refractory Crohn’s disease). There are also some anecdotic reports concerning the treatment of AIDS, coronarian Re-stenosis, atopic dermatitis, nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy), cutaneous anaplastic large cell lymphoma,Generalized deepmorphea, etc.