title: Successful implementation of a rural extracorporeal photopheresis program for the treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease in a rural hospital.
abstract: OBJECTIVE
  Extracorporeal photopheresis (ECP) is currently standard therapy for cutaneous T-cell lymphoma (CTCL) and Graft-versus-host disease (GVHD). Of the many challenges associated with outpatient ECP treatments, commuter travel to capable facilities can fragment and compromise the patient care. In 2008, our hospital implemented an ECP program providing patients to a treatment center over 120 minutes away. This study was undertaken to describe our experience with the establishment of a regional ECP program.
  
  
  METHODS
  A retrospective review using a standardized template was performed of patients treated from May 2008 to 2012. The response to treatment was analyzed after a minimum of eight procedures. A partial response to treatment in individuals with CTCL, was more than 50% skin improvement, and GVHD, a reduction in steroid dose by 50%, liver function test improvement or documented improvement in skin findings.
  
  
  RESULTS
  Of the 34 patients treated, 11 were for CTCL and 23 for GVHD. 95.8% of the 1,071 planned procedures were successfully. The average procedure time was 186 min for the UVAR-XTSTM and 93 min for the CELLEXTM. Patients travelled a median of 65.7 miles (range 4-133 miles). The median duration of therapy was 6 months (range 2-23) for CTCL and 5 months (range 1-27) for GVHD. A clinical benefit was observed in 7 of 11 (63.6%) patients with CTCL and in 15 of 23 (65.2%) with GVHD.
  
  
  CONCLUSIONS
  Our regional ECP program was a viable option in improving access to care for patients requiring treatment for CTCL and chronic GVHD.
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center.
authors.forename: Litchia L
authors.initials: LL
authors.lastname: Weber
authors.affiliation: Department of Pathology and Medicine, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Dunbar
authors.affiliation: Department of Hematology, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Meehan
authors.affiliation: Department of Pathology and Medicine, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center.
authors.forename: Zbigniew M
authors.initials: ZM
authors.lastname: Szczepiorkowski
authors.affiliation: Department of Hematology, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center.
authors.forename: Frederick
authors.initials: F
authors.lastname: Lansigan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006780:Hospitals, Rural; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D017893:Photopheresis / Q000379:methods*; D012189:Retrospective Studies; D019035:Rural Health Services; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: ECP; cutaneous T-cell lymphoma; extracorporeal photopheresis; graft-versus-host disease; implementation