Vol 5, No 1 (2019)
Review paper
Published online: 2019-04-04
Fotofereza pozaustrojowa w leczeniu chorych na twardzinę układową
DOI: 10.5603/FR.2019.0004
Forum Reumatol 2019;5(1):27-32.
Abstract
Fotofereza pozaustrojowa (ECP) jest formą terapii komórkowej o działaniu immunomodulującym. Polega na separacji leukocytów z krwi obwodowej, ich aktywacja za pomocą metoksalenu, a następnie naświetleniu promieniowaniem UVA i reinfuzji do krwiobiegu. Fotofereza pozaustrojowa znajduje zastosowanie w leczeniu choroby przeszczep przeciw gospodarzowi po allogenicznej transplantacji komórek krwiotwórczych oraz w leczeniu chłoniaków skórnych. Jej skuteczność opisano też jednak w odniesieniu do wielu chorób autoimmunologicznych, w tym twardziny układowej (SSc). W niniejszej pracy przedstawiono metodologię ECP, mechanizmy działania, a także doświadczenia kliniczne u chorych na SSc, obejmujące
trzy prospektywne badania randomizowane oraz siedem prospektywnych lub retrospektywnych analiz bez grupy porównawczej. Wskazują one, że poprawę w zakresie zmian skórnych można uzyskać u ponad połowy chorych. Metoda cechuje się dobrą tolerancją i może stanowić opcję, zwłaszcza dla chorych bez zajęcia narządów wewnętrznych.
Forum Reumatol. 2019, tom 5, nr 1: 27–32
Keywords: fotofereza pozaustrojowatwardzina układowaskuteczność
References
- Barnes J, Mayes MD. Epidemiology of systemic sclerosis: incidence, prevalence, survival, risk factors, malignancy, and environmental triggers. Curr Opin Rheumatol. 2012; 24(2): 165–170.
- Fernández-Codina A, Walker KM, Pope JE, et al. Scleroderma Algorithm Group. Treatment Algorithms for Systemic Sclerosis According to Experts. Arthritis Rheumatol. 2018; 70(11): 1820–1828.
- Couriel DR, Hosing C, Saliba R, et al. Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD. Blood. 2006; 107(8): 3074–3080.
- Kuzmina Z, Stroncek D, Pavletic SZ. Extracorporeal photopheresis as a therapy for autoimmune diseases. J Clin Apher. 2015; 30(4): 224–237.
- Zhou XA, Choi J. Photopheresis: Advances and Use in Systemic Sclerosis. Curr Rheumatol Rep. 2017; 19(6): 31.
- Klassen J. The role of photopheresis in the treatment of graft-versus-host disease. Curr Oncol. 2010; 17(2): 55–58.
- Szodoray P, Papp G, Nakken B, et al. The molecular and clinical rationale of extracorporeal photochemotherapy in autoimmune diseases, malignancies and transplantation. Autoimmun Rev. 2010; 9(6): 459–464.
- Lemke G, Rothlin CV. Immunobiology of the TAM receptors. Nat Rev Immunol. 2008; 8(5): 327–336.
- Lemke G, Burstyn-Cohen T. TAM receptors and the clearance of apoptotic cells. Ann N Y Acad Sci. 2010; 1209: 23–29.
- Xia CQ, Campbell KA, Clare-Salzler MJ. Extracorporeal photopheresis-induced immune tolerance: a focus on modulation of antigen-presenting cells and induction of regulatory T cells by apoptotic cells. Curr Opin Organ Transplant. 2009; 14(4): 338–343.
- Berger C, Hoffmann K, Vasquez JG, et al. Rapid generation of maturationally synchronized human dendritic cells: contribution to the clinical efficacy of extracorporeal photochemotherapy. Blood. 2010; 116(23): 4838–4847.
- Li H, Shi B. Tolerogenic dendritic cells and their applications in transplantation. Cell Mol Immunol. 2015; 12(1): 24–30.
- Biagi E, Di Biaso I, Leoni V, et al. Extracorporeal photochemotherapy is accompanied by increasing levels of circulating CD4+CD25+GITR+Foxp3+CD62L+ functional regulatory T-cells in patients with graft-versus-host disease. Transplantation. 2007; 84(1): 31–39.
- George JF, Gooden CW, Guo L, et al. Role for CD4(+)CD25(+) T cells in inhibition of graft rejection by extracorporeal photopheresis. J Heart Lung Transplant. 2008; 27(6): 616–622.
- Meloni F, Cascina A, Miserere S, et al. Peripheral CD4(+)CD25(+) TREG cell counts and the response to extracorporeal photopheresis in lung transplant recipients. Transplant Proc. 2007; 39(1): 213–217.
- Papp G, Horvath IF, Gyimesi E, et al. The assessment of immune-regulatory effects of extracorporeal photopheresis in systemic sclerosis: a long-term follow-up study. Immunol Res. 2016; 64(2): 404–411.
- Knobler R, Berlin G, Calzavara-Pinton P, et al. Guidelines on the use of extracorporeal photopheresis. J Eur Acad Dermatol Venereol. 2014; 28 Suppl 1: 1–37.
- Wolff D, Schleuning M, von Harsdorf S, et al. Consensus Conference on Clinical Practice in Chronic GVHD: Second-Line Treatment of Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant. 2011; 17(1): 1–17.
- UVADEX. Full Prescribing Information. http://www.therakos.co.uk/full-prescribing -information. (8.12.2018).
- Rook AH, Freundlich B, Jegasothy BV, et al. Treatment of systemic sclerosis with extracorporeal photochemotherapy. Results of a multicenter trial. Arch Dermatol. 1992; 128(3): 337–346.
- Enomoto D, Mekkes J, Bossuyt P, et al. Treatment of patients with systemic sclerosis with extracorporeal photochemotherapy (photopheresis). Journal of the American Academy of Dermatology. 1999; 41(6): 915–922.
- Knobler RM, French LE, Kim Y, et al. Systemic Sclerosis Study Group. A randomized, double-blind, placebo-controlled trial of photopheresis in systemic sclerosis. J Am Acad Dermatol. 2006; 54(5): 793–799.
- Di Spaltro FX, Cottrill C, Cahill C, et al. Extracorporeal photochemotherapy in progressive systemic sclerosis. Int J Dermatol. 1993; 32(6): 417–421.
- Cribier B, Faradji T, Le Coz C, et al. Extracorporeal photochemotherapy in systemic sclerosis and severe morphea. Dermatology. 1995; 191(1): 25–31.
- Fimiani M, Rubegni P, Flori ML, et al. Three cases of progressive systemic sclerosis treated with extracorporeal photochemotherapy. Arch Dermatol Res. 1997; 289(2): 120–122.
- Krasagakis K, Dippel E, Ramaker J, et al. Management of severe scleroderma with long-term extracorporeal photopheresis. Dermatology. 1998; 196(3): 309–315.
- Muellegger RR, Hofer A, Salmhofer W, et al. Extended extracorporeal photochemotherapy with extracorporeal administration of 8-methoxypsoralen in systemic sclerosis. An Austrian single-center study. Photodermatol Photoimmunol Photomed. 2000; 16(5): 216–223.
- Papp G, Horvath IF, Gyimesi E, et al. Immunomodulatory effects of extracorporeal photochemotherapy in systemic sclerosis. Clin Immunol. 2012; 142(2): 150–159.
- Reich S, Gambichler T, Altmeyer P, et al. Extracorporeal photopheresis in systemic sclerosis: effects on organ involvement? J Am Acad Dermatol. 2007; 56(2): 348–349.
- Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher. 2013; 28(3): 145–284.
