Marshall Scott R
Department of Haematological Sciences, School of Clinical and Laboratory Sciences, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Nat Clin Pract Oncol. 2006 Jun;3(6):302-14. doi: 10.1038/ncponc0511.
Hematopoietic stem-cell transplantation remains an important curative therapy for many conditions and its use is increasing annually. Graft-versus-host disease (GvHD) is the major cause of mortality and suffering following allogeneic hematopoietic stem-cell transplantation. Conventional treatments are associated with multiple side effects and are often ineffective. New therapeutic approaches for the control of GvHD are desperately required. Extracorporeal photochemotherapy (ECP) was developed in the 1970s for the treatment of cutaneous T-cell lymphoma and was approved by the FDA as the first selective immunotherapy for a cancer. ECP has also proved an effective therapy for immune-related conditions, particularly GvHD, even in patients refractory to conventional therapies. The treatment involves the mechanical separation of circulating white cells, which are exposed to psoralen and UVA light and then returned to the patient. ECP is extremely well tolerated with minimal side effects and is not associated with the increased rates of infection or relapse of malignant disease typical of conventional immunosuppressive agents. Thus, ECP appears to offer selective immune modulation without generalized immunosuppression, but its mechanism of action remains poorly understood. This review discusses the development of ECP, its use in the treatment of GvHD, as well as current theories of its mechanism of action.
造血干细胞移植仍然是许多疾病的重要治愈性疗法，且其应用每年都在增加。移植物抗宿主病（GvHD）是异基因造血干细胞移植后导致死亡和痛苦的主要原因。传统治疗伴有多种副作用且往往无效。迫切需要控制GvHD的新治疗方法。体外光化学疗法（ECP）于20世纪70年代开发用于治疗皮肤T细胞淋巴瘤，并被美国食品药品监督管理局（FDA）批准为第一种用于癌症的选择性免疫疗法。ECP也已被证明是治疗免疫相关疾病，特别是GvHD的有效疗法，即使在对传统疗法难治的患者中也是如此。该治疗包括机械分离循环白细胞，将其暴露于补骨脂素和紫外线A光下，然后再回输给患者。ECP耐受性极佳，副作用极小，且与传统免疫抑制剂典型的感染率增加或恶性疾病复发无关。因此，ECP似乎能提供选择性免疫调节而无全身性免疫抑制，但其作用机制仍知之甚少。本综述讨论了ECP的发展、其在治疗GvHD中的应用以及当前关于其作用机制的理论。
