Extrakorporale Photopherese

Zusammenfassung

Bei der extrakorporalen Photopherese (ECP) handelt es sich um ein Therapiekonzept, das eine Leukapherese mit einer UVA-Lichtbestrahlung verbindet. Die durch Leukapherese gewonnenen kernhaltigen Zellen wie Lymphozyten und Monozyten werden nach Zugabe eines Photosensitizers (8-Methoxypsoralen) extrakorporal mit UVA-Licht bestrahlt werden. Für die Durchführung der ECP stehen unterschiedliche technische Geräte zur Verfügung. Bei Verwendung von geschlossenen (inline) Systemen werden die Zellsammlung und Bestrahlung ohne nötige Zwischenschritte mit demselben Equipment ausgeführt, wohingegen bei offenen (offline) Systemen die Zellsammlung mit einem konventionellen Blutzellseparator durchgeführt wird und die mit 8-Methoxypsoralen versetzten Zellen nach Überleiten in einen UVA-durchlässigen Beutel mit einer externen UVA-Licht-Quelle bestrahlt werden. Der therapeutische Effekt beruht auf einer Modulation des zellulären Immunsystems, wodurch es zu einer Abnahme der T-Zell-Aktivität kommt. Die ECP ist fixer Bestandteil in der Behandlung des kutanen T-Zell-Lymphoms, der akuten und chronischen Graft-versus-Host-Erkrankung nach allogener hämatopoietischer Stammzelltransplantation und der Behandlung von Abstoßungsepisoden nach Herz- und Lungentransplantation. Durch experimentelle wie auch klinische Untersuchungen zur Wirkung der ECP auf das Immunsystem kam es in den letzten Jahren zu einer Erweiterung des Indikationsspektrums wie zum Beispiel auf frühe Stadien der systemischen Sklerodermie (kutane Komponente). Die ECP ist eine sichere und effektive Behandlungsoption, die mit einer geringen Nebenwirkungsrate einhergeht.

Abstract

Extracorporeal photopheresis (ECP) combines a leukapheresis procedure with UVA irradiation where nucleated cells such as lymphocytes and monocytes undergo extracorporeal UVA irradiation after a photosensitizer (8-Methoxypsoralen) has been added. ECP can be performed using different technical devices. The closed (inline) system consists of an apheresis device with an incorporated UVA source. Cells are collected and irradiated without being discontinued from the patient. In contrast, open (offline) systems use a conventional blood cell separator for mononuclear cell collection and a separate UVA source for irradiation. The therapeutic effect of ECP is based on a modulation of the cellular immune system leading to a reduction in T-cell activity. ECP is an integral part in the treatment of cutaneous T-cell lymphoma, acute and chronic graft-versus-host disease after allogeneic stem cell transplantation, and rejection episodes after heart and lung transplantation. Due to recent findings in the mechanism of action on the immune system, indications for ECP have been expanded to treat a range of additional diseases such as early systemic sclerosis (cutaneous component). ECP is a safe and effective treatment modality and associated with few side effects.

Schlüsselwörter

Wirkmechanismus der extrakorporalen Photopherese - kutanes T-Zell-Lymphom - Graft-versus-Host-Erkrankung - Abstoßung nach Organtransplantation - systemische Sklerodermie

Key words

mechanism of action of extracorporeal photopheresis - cutaneous T-cell lymphoma - graft-versus-host disease - rejection after solid organ transplantation - systemic sclerosis

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