Recent insights into extracorporeal photopheresis for graft-versus-host disease

ABSTRACT

Introduction

Extracorporeal Photopheresis (ECP) may be considered the unique large-scale cell therapy currently available. It is currently employed mainly as second-line treatment, especially in steroid-resistant or steroid-dependent Graft versus Host Disease (GvHD) with good results and very few limitations.

Areas covered

Many points need to be clarified regarding the ECP mechanism of action, that conditions the lack of uniqueness among the different centers, essentially cycle frequency, treatment duration, and the number of cells to be treated to obtain a response, according to the organs involved. Moreover, reliable biomarkers for prediction of response are lacking, as well as the best pharmacological combination. We will focus on the recent advances concerning ECP for GvHD treatment. We performed a systematic literature research in Pubmed and Embase as of September 2023.

Expert opinion

The recent studies on ECP mechanism of action along with the promising biomarkers of response, and the synergistic benefit of ECP in association with the new drugs render this therapy an important weapon for GvHD resistant to conventional treatment and can be proposed as a valid first-line therapy option with promising results. We believe that it should be used early in all categories of patients, considering its high safety profile.

KEYWORDS:

• Extracorporeal photopheresis
• ECP
• graft versus host disease
• GVHD
• allogeneic stem cell transplantation
• cell therapy
• UV-A irradiation
• 8-methoxypsoralen

Article highlights

• ECP is feasible, safe, and effective in the treatment of acute and chronic GvHD with no adjunctive infectious risk or disease relapse.

• Optimal timing and frequency of ECP need to be defined to tailor the procedure based on the type of disease (acute or chronic GvHD) and organ involvement.

• Patients with lung cGvHD have poor survival. ECP seems to be a promising adjunctive treatment to hinder, and, at best, reverse lung function decline.

• Biological markers for the prediction of response to ECP are lacking; nevertheless, some promising biomarkers are emerging (e.g. miRNAs).

• ECP in association with newly available drugs (e.g. ruxolitinib) may be a promising option to obtain a better response.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Aknowledgments

The authors thank the Librarian Valeria Scotti for their help in the literature search.

Notes

1. Figure 1 was created with BioRender.com.

Additional information

Funding

This paper was not funded.