title: National Institutes of Health State of the Science Symposium in Therapeutic Apheresis: scientific opportunities in extracorporeal photopheresis.
abstract: 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.
authors.affiliation: Department of Pathology and Laboratory Medicine, Department of Veterans Affairs, White River Junction, VT; Transfusion Medicine, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: nora.ratcliffe@dartmouth.edu.
authors.forename: Nora
authors.initials: N
authors.lastname: Ratcliffe
authors.affiliation: Transfusion Medicine, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Dunbar
authors.affiliation: Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ.
authors.forename: Jill
authors.initials: J
authors.lastname: Adamski
authors.affiliation: Hematology-Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Daniel
authors.initials: D
authors.lastname: Couriel
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, CT.
authors.forename: Richard
authors.initials: R
authors.lastname: Edelson
authors.affiliation: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kitko
authors.affiliation: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI.
authors.forename: John E
authors.initials: JE
authors.lastname: Levine
authors.affiliation: Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
authors.forename: Shanna
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Therapeutic Apheresis Program, Department of Hematology/Oncology/Stem Cell Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schneiderman
authors.affiliation: Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Steve
authors.initials: S
authors.lastname: Sloan
authors.affiliation: Puget Sound Blood Center, Seattle, WA.
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Transfusion Medicine, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Zbigniew M
authors.initials: ZM
authors.lastname: Szczepiorkowski
authors.affiliation: Blood Bank and Transfusion Services, Department of Pathology, University of Michigan, Ann Arbor, MI.
authors.forename: Laura
authors.initials: L
authors.lastname: Cooling
mesh_terms: D035843:Biomedical Research / Q000379:methods / Q000639:trends; D001781:Blood Component Removal / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D003226:Congresses as Topic / Q000458:organization & administration; D003713:Dendritic Cells / Q000166:cytology; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology; D009316:National Institutes of Health (U.S.) / Q000458:organization & administration; D017893:Photopheresis / Q000706:statistics & numerical data; D013601:T-Lymphocytes / Q000166:cytology; D014481:United States
keywords: Apheresis; Blood component removal; Extracorporeal photopheresis; Ultraviolet therapy