Involves the collection of a small proportion (5%) of a patient’s mononuclear cells by apheresis, exposing them to UVA light + psoralen, then re-infusing them.
May be done by open or closed systems.
Open system: buffy coat is collected then separated. UVA irradiation occurs in a separate device before reinfusion.
Closed system: apheresis device contains an internal UVA source, so no separation of the buffy coat is necessary before return to the patient.
Open systems allow manipulation of cells and increased cell doses. However, there is an increased risk of microbial contamination.
Indications for ECP:
Erythrodermic cutaneous T cell lymphomas: ECP induces remissions in early and late mycosis fungoides and Sezary syndrome (first-line).
Chronic GVHD (second-line): mainly for skin, liver or mucosal disease, for patients who are refractory to, intolerant of, or dependent on steroids.
Steroid-refractory acute GVHD.
Prevention of heart, lung, renal and face transplant rejection.
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