Extracorporeal photopheresis in chronic graft-versus-host disease.
Despite significant advances in stem cell manipulation and post-transplant immunosuppression, chronic graft-versus-host disease (cGVHD) remains a cause of major long-term morbidity in survivors of allogeneic stem cell transplantation. Extracorporeal photopheresis (ECP) is a novel therapeutic intervention which has demonstrated efficacy in patients with refractory acute and chronic GVHD. Clinical responses have been reported in skin and visceral GVHD. While the long-term immunomodulatory effects of ECP in cGVHD are unknown, recent studies of patients undergoing a 6- to 12-month course of ECP treatment demonstrated an attenuation of Th1-mediated cytokine secretion by activated T-helper cells, a shift in the DC1/DC2 ratio favoring plasmacytoid rather than monocytoid dendritic cell profiles, and a decrease in antigen responsiveness by dendritic cells. The implications of these immunomodulatory effects of ECP on pathogenesis and clinical outcome remains a fertile area for future research.
Foss
F M
FM
Bone Marrow Transplantation and Experimental Therapeutics, Tufts New England Medical Center, Boston, MA 02111, USA.
Gorgun
G
G
Miller
K B
KB
D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007107:Immune System / Q000166:cytology / Q000378:metabolism; D017893:Photopheresis