RESUMEN
BACKGROUND: After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. MATERIALS AND METHODS: In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. RESULTS AND CONCLUSION: These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion.
Asunto(s)
Enfermedades Autoinmunes/tratamiento farmacológico , Linfoma Cutáneo de Células T/tratamiento farmacológico , Fotoféresis/estadística & datos numéricos , Fármacos Fotosensibilizantes/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Rechazo de Injerto/tratamiento farmacológico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Humanos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Fotoféresis/métodos , Esclerodermia Sistémica/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Linfoma Cutáneo de Células T/tratamiento farmacológico , Fotoféresis/estadística & datos numéricos , Neoplasias Cutáneas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Terapia Combinada/estadística & datos numéricos , Femenino , Humanos , Linfoma Cutáneo de Células T/mortalidad , Masculino , Auditoría Médica , Persona de Mediana Edad , Fotoféresis/mortalidad , Neoplasias Cutáneas/mortalidad , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: To describe the indicidence and severity of iron deficiency anemia (IDA) in patients who have received extracorporeal photopheresis (ECP) treatment of cutaneous T-cell lymphoma (CTCL). METHODS: We performed a retrospective study during a 9-year period of patients with CTCL who were treated with ECP. ECP was performed with UVAR XTS and CELLEX (Therakos Inc). IDA was defined by a drop in hemoglobin (Hb), mean cell volume (MCV), and increased red blood cell distribution width (RDW). RESULTS: We identified a total of 36 patients; 1 patient was excluded due to severe anemia. In 35 patients, initial hemoglobin values ranged from 9.8 g per dL to 15.9 g per dL, and patients received 4 to 327 ECP treatments. In all, 28 patients showed decreases in Hb of 0.8 g per dL to 6 g per dL during treatments. CONCLUSION: Chronic ECP led to IDA in 28 of 35 patients with CTCL. IDA occurs due to blood loss when ECP equipment does not return full blood volume to patients.
Asunto(s)
Anemia Ferropénica/epidemiología , Linfoma Cutáneo de Células T/terapia , Fotoféresis/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotoféresis/estadística & datos numéricosRESUMEN
Data collection on apheresis activities in Italy throughout 2005 including techniques, types of blood cell separators, clinical indications and adverse effects was performed by means of a standardized questionnaire. These data provided by 83 Apheresis Units from 16 Italian regions, albeit rough, are sufficiently informative, mainly in comparison with previous surveys on these statistics (1997 and 2000). In 2005 a total number of 204,746 apheresis procedures were carried out, with a clear-cut prevalence of apheresis production (87.7%), performed by 66 out of 83 Apheresis Units (79.5). Lombardy, Veneto and Tuscany were the most active regions for therapeutic apheresis (51.1% of the total national procedures). An increasing number in extracorporeal photochemotherapy as compared to the 2000 national survey (3,386 vs. 704 procedures) is the most striking observation to emerge from the 2005 data collection on therapeutic apheresis in Italy. Adverse effects, predominantly mild ones (i.e., paresthesia due to citrate-induced hypocalcemia), occurred in 0.12% of apheresis production and 6.04 of therapeutic sessions, particularly in the course of peripheral blood stem cell collection (20.79%), as already reported in the 2000 national survey.
Asunto(s)
Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Eliminación de Componentes Sanguíneos/efectos adversos , Eliminación de Componentes Sanguíneos/instrumentación , Eliminación de Componentes Sanguíneos/métodos , Transfusión de Sangre Autóloga/estadística & datos numéricos , Trasplante de Médula Ósea/estadística & datos numéricos , Diseño de Equipo , Encuestas de Atención de la Salud , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Humanos , Italia/epidemiología , Fotoféresis/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
INTRODUCTION: Acute antibody-mediated rejection (AAMR) is the subject of much research. It is diagnosed by C4d staining at biopsy and circulating donor-specific antibodies (DSA). The combination of intensive plasmapheresis and intravenous immunoglobulin (IVIG) has been recognized as an effective treatment for AAMR. We report our single-center experience on AAMR treatment. MATERIALS AND METHODS: We treated 23 transplanted patients (group A) with protein-A immunoadsorption (IA) and 7 patients (group B) with double-filtration plasmapheresis. All patients were treated with IVIG (400 mg/kg/d). Basic immunosuppression included cyclosporine, steroids, azathioprine, and antilymphocyte globulin or monoclonal antibodies (OKT3). A subgroup of 3 patients (3/7; group B1) was treated with photopheresis. RESULTS: In both groups, the mean number of extracorporeal procedures was 7.3 ± 4.5 and 5.5, respectively; the mean duration of treatment was 12.3 ± 10.2 and 14.5 days, respectively. In group A, we observed negative cross-matching in 96% after mean of 18 days; 1 patient died from sepsis, and 6 lost their grafts. In group B, negative circulating DSA were observed in all patients after a mean of 25 days, and 1 patient lost their allograft. CONCLUSIONS: In our observation, the 2 extracorporeal procedures had similar effects in terms of graft survival, DSA removal, and cross-match negativity (group A 74% vs 86%; 95.6% vs 100%). IA was faster for DSA removal. In our opinion, the higher costs of IA suggests its use just in high-risk cases, such as in hyperimmune or sensitized patients. Further studies are necessary to improve our knowledge.
Asunto(s)
Anticuerpos/inmunología , Rechazo de Injerto/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Trasplante de Riñón/efectos adversos , Fotoféresis/estadística & datos numéricos , Plasmaféresis/estadística & datos numéricos , Adulto , Anticuerpos/efectos adversos , Anticuerpos/sangre , Femenino , Rechazo de Injerto/inmunología , Humanos , Terapia de Inmunosupresión/métodos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The clinical use of extracorporeal photopheresis (ECP) for accepted indications such as graft-versus-host disease, transplant rejection, and cutaneous T-cell lymphoma continues to increase. Expanded applications for ECP, such as the treatment of select autoimmune diseases, are being explored. Extracorporeal photopheresis's capacity to both immunotolerize in the autoreactive setting, while immunizing against a lymphoma is unusual and suggestive of a unique mechanism. It is likely that ECP's induction of dendritic cells is key to its efficacy in both of these settings, but exactly how ECP impacts other immune components and their interactions is not fully understood. Further basic science research is necessary to elucidate how these dissimilar cellular activities are functionally integrated. On the clinical side, collaborative multicenter trials designed to recognize the principal variables controlling therapeutic responses and improve prognostic indicators may enable tailoring devices, treatment schedules, and doses to the needs of the individual patients or diseases. This review describes our current understanding of how ECP influences the immune system, reviews the existing clinical applications of ECP, and explores areas for future basic science and clinical research as presented at the National Institutes of Health State of the Science Symposium in Therapeutic Apheresis in November 2012.
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Investigación Biomédica , Eliminación de Componentes Sanguíneos/tendencias , Congresos como Asunto , Fotoféresis , Investigación Biomédica/métodos , Investigación Biomédica/tendencias , Eliminación de Componentes Sanguíneos/métodos , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Congresos como Asunto/organización & administración , Células Dendríticas/citología , Humanos , Células Asesinas Naturales/citología , National Institutes of Health (U.S.)/organización & administración , Fotoféresis/estadística & datos numéricos , Linfocitos T/citología , Estados UnidosAsunto(s)
Modalidades de Fisioterapia/estadística & datos numéricos , Enfermedades de la Piel/terapia , Balneología , Aprobación de Recursos , Humanos , Fotoféresis/instrumentación , Fotoféresis/estadística & datos numéricos , Fototerapia/estadística & datos numéricos , Modalidades de Fisioterapia/instrumentación , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Extracorporeal photochemotherapy (ECP) is an immunomodulating procedure consisting of autologous reinfusion of peripheral blood mononuclear cells (PBMC) after direct exposure to 8-methoxy-psoralen and UV-A. It has been described as a successful treatment for different T-cell-mediated diseases and preliminary results suggest that ECP might be effective in the treatment of relapsing-remitting multiple sclerosis, but does not significantly alter the course of the progressive form of MS. In this study, we report the safety data and some preliminary efficacy evidence obtained using ECP in the treatment of five patients with refractory relapsing-remitting (RR) MS: in most cases ECP induced a reduction in the relapse rate and an EDSS stabilisation, with an apparent general MRI stabilisation. In conclusion, our results confirm ECP safety and tolerability and suggest that this treatment might be useful as a therapeutic alternative in the subgroup of RRMS patients not responsive to or not eligible for traditional immunomodulating or immunosuppressive treatments.