What is extracorporeal photopheresis?

On November 29, 2022, the GvHD Hub held a virtual symposium on the role of extracorporeal photopheresis (ECP) in the management of graft-versus-host disease (GvHD).

Here, we share the presentation given by Professor Hildegard Greinix, Medical University of Graz, Graz, AT, which considered ECP and how it works.

In this presentation, Professor Greinix details the process of ECP (Figure 1), as well as its direct and indirect effects at a cellular level, and discusses the use of ECP, alone or in combination, for both chronic and acute GvHD, and its impact on quality of life (Figure 2), referencing data and outcomes from multiple research studies.

Figure 1. The process of ECP* 

ECP, extracorporeal photopheresis; GvHD, graft-versus-host disease; UVA, ultraviolet A.
*Adapted from Knobler, et al.¹ Created with BioRender.com.

Figure 2. Quality of life during ECP treatment*^† 

ECP, extracorporeal photopheresis; SF-36, 36-item short form health survey; SoC, standard of care.
*Copyright © 2022 by Elsevier. Reproduced with permission. Jagasia M, et al. Randomized controlled study of ECP with methoxsalen as first-line treatment of patients with moderate to severe cGVHD Blood Adv. 2019;3(14):2218-2229. DOI: 10.1182/bloodadvances.2019000145^2
†The SF-36 domains of quality of life were scored from 0 to 100.

Watch or download the presentation to learn more about ECP, including:

• What ECP is and how it works (0:16; slides 5–6)
• The Impacts of ECP (3:00; slides 7–8)
• ECP in acute GvHD (5:17; slides 10–17)
• ECP in chronic GvHD (15:09; slides 19–28)
• Quality of life during treatment (25:33; slides 29–30)
• Combination treatments with ECP (26:32; slides 32–35)
• Approved and recommended uses for ECP (33:56; slides 37–38)

Key points

• ECP is a process in which blood is externally centrifuged and white blood cells are treated with methoxsalen and ultraviolet A light before being returned to the patient.
• ECP causes the depletion of alloreactive donor T cells that can cause GvHD.
• ECP is associated with superior survival compared with anticytokine therapy.
• Treatment with ECP is well tolerated, with no severe cytopenias recorded.
• ECP is approved for the treatment of advanced cutaneous T-cell lymphoma.
• ECP is recommended as a second-line treatment for steroid-refractory acute and chronic GvHD.