Extracorporeal Photochemotherapy

ECP is a leukapheresis-based method in which 8-MOP treated blood mononuclear cells are exposed to UVA and returned to the patient. It is performed on two consecutive days every month. Although the mechanism of action is not completely understood, induction of apoptosis with subsequent release of tumor antigens leading to a systemic antitumor response against the malignant T-cell clone is suspected.65 66 In 1987 Edelson et al. published the first report on the efficacy of ECP in a cohort of 41 refractory CTCL patients. Thirty-seven patients (73%) achieved a response, with a CR in 24% of patients.67 In the same year the FDA approved ECP for advanced and refractory CTCL. There have been several confirmatory studies reported on ECP monotherapy, with overall response rates between 50 and 73% for patients with MF/SS.67-70 Ideal candidates for ECP are patients with

SS with a short duration of disease without previous intense therapies, low tumor burden, modest numbers of circulating atypical cells, near normal counts of circulating CD8+ T lymphocytes, and exaggerated CD4 to CD8 ratio.68-70 The results in patients with marked immunosuppression or tumor lesions were disappointing, but provided the rationale for combining treatments. Synergistic effects have been reported with INF-a, retinoids, and TSEB.70-73 A retrospective study of 47 patients with advanced stage III-IV disease treated with ECP or with ECP combination therapy with INF-a, retinoids, or sargramostim reported an overall response rate of 79%.71 The overall response rate in patients who received combination therapy was 84%, with a CR in 26% of patients. The median survival for the patients undergoing combination therapy was 74 months. The effect of ECP as adjuvant therapy was evaluated in patients with advanced stage T3 and T4 disease who achieved a CR after TSEB treatment. Significantly better overall survival at 3 years was reported with adjuvant doxorubicin/cyclophosphamide (75%) or with adjuvant ECP (100%) compared to those with TSEB therapy (50%) alone.73

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