Photopheresis

Last updated
Photopheresis
ICD-10-PCS 6A650ZZ [note 1]
ICD-9 99.88
MeSH D017893

In medicine, photopheresis (akaextracorporeal photopheresis or ECP) [1] is a form of apheresis and photodynamic therapy in which blood is subject to apheresis to separate buffy coat (WBC + platelets) from whole blood, chemically treated with 8-methoxypsoralen (instilled into a collection bag or given per os in advance), exposed to ultraviolet light (UVA), and then returned to the patient. [2] Activated 8-methoxypsoralen crosslinks DNA in exposed cells, ultimately resulting apoptosis of nucleated cells. [1] The photochemically damaged T-cells returned to the patient appear to induce cytotoxic effects on T-cell formation. The mechanism of such “antitumor” action has not been elucidated.

Contents

A 1987 New England Journal of Medicine publication introduced photopheresis involving 8-methoxypsoralen., [1] [3] now standard U.S. Food and Drug Administration (FDA) therapy for cutaneous T-cell lymphoma. Evidence suggests that this treatment might help treat graft-versus-host disease, though this evidence is largely observational; controlled trials are needed to support this use. [4] [5] Photopheresis has also been successful in treating epidermolysis bullosa acquisita when all other treatments have been ineffective. [6]

Minimal observed side effects for patients receiving photopheresis include hypotension and syncope resulting from volume shifts during leukapheresis phase of treatment. Photopheresis is also an experimental treatment for patients with cardiac, pulmonary and renal allograft rejection, graft-versus-host disease, autoimmune diseases, nephrogenic systemic fibrosis and ulcerative colitis.

See also

Notes

  1. ICD10 Procedure code: this was assigned based on cross-walking from the ICD9 code at ICD10DAta.com

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Hematopoietic stem-cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood, in order to replicate inside a patient and produce additional normal blood cells. HSCT may be autologous, syngeneic, or allogeneic.

<span class="mw-page-title-main">Graft-versus-host disease</span> Medical condition

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<span class="mw-page-title-main">Epidermolysis bullosa</span> Rare medical conditions that result in easy blistering of the skin and mucous membranes

Epidermolysis bullosa (EB) is a group of rare medical conditions that result in easy blistering of the skin and mucous membranes. Blisters occur with minor trauma or friction and are painful. Its severity can range from mild to fatal. Inherited EB is a rare disease with a prevalence in the United States of 8.2 per million live births. Those with mild cases may not develop symptoms until they start to crawl or walk. Complications may include esophageal narrowing, squamous cell skin cancer, and the need for amputations.

<span class="mw-page-title-main">Keratin 14</span> Protein found in humans

Keratin 14 is a member of the type I keratin family of intermediate filament proteins. Keratin 14 was the first type I keratin sequence determined. Keratin 14 is also known as cytokeratin-14 (CK-14) or keratin-14 (KRT14). In humans it is encoded by the KRT14 gene.

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<span class="mw-page-title-main">Genodermatosis</span> Genetic skin disease

Genodermatosis is a hereditary skin disease with three inherited modes including single gene inheritance, multiple gene inheritance and chromosome inheritance. There are many different types of genodermatosis; the prevalence of genodermatosis ranges from 1 per 6000 people to 1 per 500,000 people. Genodermatosis has influence on the texture, color and structure of skin cuticle and connective tissue, specific lesion site and clinical manifestations on the body vary depending on the type. In the spite of the variety and complexity of genodermatosis, there are still some common methods that can help people diagnose. After diagnosis, different types of genodermatosis require different levels of therapy including interventions, nursing interventions and treatments. Among that, research of therapy for some new, complex and rare types are still in the developing stage. The impact of genodermatosis not only can be seen in body but also can be seen in all aspects of patients' life, including but not limited to psychological, family life, economic conditions and social activities. Accordingly, the patients need treatment, support and help in these areas.

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References

  1. 1 2 3 Klassen, J (2010). "The role of photopheresis in the treatment of graft-versus-host disease". Current Oncology. 17 (2): 55–8. doi:10.3747/co.v17i2.565. PMC   2854639 . PMID   20404979. Open Access logo PLoS transparent.svg
  2. "National Coverage Determination (NCD) for Extracorporeal Photopheresis (110.4)". Medicare Coverage Database. Centers for Medicare and Medicaid Services. 30 April 2012. Item/Service Description. 100-3.
  3. Edelson, R; Berger, C; Gasparro, F; Jegasothy, B; Heald, P; Wintroub, B; Vonderheid, E; Knobler, R; Wolff, K; Plewig, G; McKiernan, Glynis; Christiansen, Inger; Oster, Martin; Honigsmann, Hubert; Wilford, Hubert; Kokoschka, Eva; Rehle, Thomas; Perez, Maritza; Stingl, George; Laroche, Liliane (1987). "Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. Preliminary results". New England Journal of Medicine. 316 (6): 297–303. doi:10.1056/NEJM198702053160603. PMID   3543674. Closed Access logo transparent.svg
  4. Buder, Kathrin; Zirngibl, Matthias; Bapistella, Sascha; Meerpohl, Joerg J.; Strahm, Brigitte; Bassler, Dirk; Weitz, Marcus (2022-06-09). "Extracorporeal photopheresis versus alternative treatment for chronic graft-versus-host disease after haematopoietic stem cell transplantation in children and adolescents". The Cochrane Database of Systematic Reviews. 2022 (6): CD009898. doi:10.1002/14651858.CD009898.pub4. ISSN   1469-493X. PMC   9181448 . PMID   35679154.
  5. Buder, Kathrin; Zirngibl, Matthias; Bapistella, Sascha; Meerpohl, Joerg J.; Strahm, Brigitte; Bassler, Dirk; Weitz, Marcus (2022-09-27). "Extracorporeal photopheresis versus standard treatment for acute graft-versus-host disease after haematopoietic stem cell transplantation in children and adolescents". The Cochrane Database of Systematic Reviews. 2022 (9): CD009759. doi:10.1002/14651858.CD009759.pub4. ISSN   1469-493X. PMC   9514720 . PMID   36166494.
  6. Gupta, R; Woodley, D. T.; Chen, M (2012). "Epidermolysis bullosa acquisita". Clinics in Dermatology. 30 (1): 60–9. doi:10.1016/j.clindermatol.2011.03.011. PMC   3234994 . PMID   22137228. Open Access logo PLoS transparent.svg

Further reading