Abstract
Photopheresis is a relatively safe and technically simple modality for immunomodulation. The extracorporeal activation of a drug with UVA constitutes a novel form of drug delivery. The usefulness of this system in erythrodermic CTCL is well established. Immunomodulating therapy can thus be conducted outside the host where controlled conditions permit cellular manipulations not possible in the intact patient. Indeed, if one wished, as we did, to develop a system capable of stimulating an immunological response to damage, reinfused lymphocytes, the use of an extracorporeally photo-activated drug presents a distinctive special advantage. Because the only blood components immediately impacted by the photoactivated drug will be those in the extracorporeal system, mononuclear leukocytes localized to the reticuloendothelial system will be uninhibited by the drug. Therefore, unlike with classical chemotherapy which exposes the total body to the effects of the drugs, photopheresis leaves the reticuloendothelial system intact and capable of responding to the reinfused cells. This system is an excellent paradigm for future immunomodulating therapies of malignant diseases.
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