Extracorporeal photochemotherapy: a safety and tolerability pilot study with preliminary efficacy results in refractory relapsing-remitting multiple sclerosis

Abstract Extracorporeal photochemotherapy (ECP) is an immunomodulating procedure consisting of autologous reinfusion of peripheral blood mononuclear cells (PBMC) after direct exposure to 8-methoxy-psoralen and UV-A. It has been described as a successful treatment for different T-cell-mediated diseases and preliminary results suggest that ECP might be effective in the treatment of relapsing–remitting multiple sclerosis, but does not significantly alter the course of the progressive form of MS. In this study, we report the safety data and some preliminary efficacy evidence obtained using ECP in the treatment of five patients with refractory relapsing-remitting (RR) MS: in most cases ECP induced a reduction in the relapse rate and an EDSS stabilisation, with an apparent general MRI stabilisation. In conclusion, our results confirm ECP safety and tolerability and suggest that this treatment might be useful as a therapeutic alternative in the subgroup of RRMS patients not responsive to or not eligible for traditional immunomodulating or immunosuppressive treatments.     

Extra corporeal photochemotherapy in steroid refractory graft versus host disease: A review of guidelines and recommendations

Regardless of remarkable progresses in prevention and treatment approaches, graft versus host disease (GVHD) remains a major impediment for successful allogeneic hematopoietic stem cells transplantation (HSCT) and leads to morbidity and mortality in transplanted patients. Corticosteroids are the standard therapy for GVHD; however, a great number of patients will not respond sufficiently and others will be significantly affected by adverse effects of steroids. Extracorporeal photochemotherapy (ECP), as one of the numerous second line therapies, through modulation of immune cells may improves GVHD affected organ function in steroid-refractory forms. Considering to widespread utilization of ECP as a therapeutic strategy, we performed review on current literature of ECP, regarding the treatment strategies, monitoring protocols and technical aspects in chronic and acute GVHD.     

进展期食管贲门胃底癌内镜下三联治疗

目的研究失去手术、放疗、全身化疗机会的进展期食管＿贲门＿胃底癌内镜下三联疗法的疗效。方法采用激光光动力学加微波局部注射化疗药物的内镜下三联治疗法，共治疗１９例患者，并根据患者食管梗阻程度、内镜下肿瘤类型、病变范围，对进展期食管贲门胃底癌采用不同方法进行治疗。结果获得显著疗效者１４例，有效者５例。结论内镜下三联治疗法，是一种安全、有效治疗进展期食管＿贲门＿胃底癌的方法     

Regional anticoagulation with acid citrate dextrose-A for extracorporeal photoimmunochemotherapy

BACKGROUND AND OBJECTIVES: During photopheresis, intravenous heparin is used to prevent clotting in the extracorporeal circuit. Regional citrate anticoagulation could lower the risks associated with heparin treatment. MATERIALS AND METHODS: Four-hundred and six photophereses procedures that were anticoagulated by acid citrate dextrose-A (ACD-A) (of which 343 were performed in patients at risk for haemorrhage) were analysed together with 278 heparin-anticoagulated treatments. RESULTS: Four-hundred and four of 406 citrate treatments were completed. Seven transient paresthesias (1.73%), five of which occurred in the first 50 treatments, were observed. Bleeding complications were noted during heparin anticoagulation (1.07%), but not during citrate anticoagulation. During photopheresis, haemoglobin values and platelet counts decreased by 11.4% and 14.6%, respectively (P < 0.0001). Twenty-four hours after treatment, haemoglobin values, and platelet and leucocyte counts were still lower than at baseline (P < 0.0001). The changes of haemoglobin, platelet and leucocyte values did not differ for citrate and heparin. CONCLUSIONS: In patients with contraindications against heparin use, ACD-A citrate anticoagulation during photopheresis is a safe and efficient alternative. Photopheresis induces profound changes of the blood count, irrespective of the anticoagulation method.     

5-氨基酮戊酸光动力疗法治疗寻常痤疮的临床观察

目的观察5-氨基酮戊酸光动力疗法(ALA-PDT)治疗寻常痤疮的安全性及有效性。方法将90例中重度痤疮患者随机单盲分为两组:治疗组45例,给予ALA-PDT治疗,1次/10 d,共治疗2～4次;对照组45例,口服异维A酸胶囊,每次10 mg,2次/d,共治疗40 d。在治疗的第10、20、30及40天对两组患者进行疗效判断和比较,同时,记录治疗过程中出现的不良反应。结果治疗组患者经过2～4次治疗后,总有效率为97.8%;对照组治疗结束时总有效率为77.8%,治疗组疗效明显优于对照组(P<0.01)。另外,治疗组复发程度明显低于对照组,且病情控制时间明显延长。治疗组的所有皮损,包括粉刺、丘疹、脓疱、囊肿、结节等均比对照组明显减少。结论 ALA-PDT治疗中重度痤疮的疗效明显优于口服异维A酸胶囊,是一种简单、高效、不良反应轻微的治疗中重度寻常痤疮的新方法。     

微波联合5-氨基酮戊酸及光动力疗法治疗肛管内尖锐湿疣

目的评价微波联合5-氨基酮戊酸及光动力疗法(ALA-PDT)治疗尖锐湿疣的疗效。方法将86例尖锐湿疣患者分为两组,每组43例。治疗组采用微波、5-氨基酮戊酸与ALA-PDT联合治疗,对照组单用微波治疗。结果治疗组患者痊愈率为83.7%(36/43),复发率为4.7%(2/43);对照组痊愈率为67.4%(29/43),复发率为18.6%(8/43)。两组痊愈率及复发率比较,差异有显著统计学意义(P<0.01)。结论微波联合5-氨基酮戊酸及光动力疗法治疗尖锐湿疣在疗效及复发率方面均明显优于微波治疗。     

Effect of Hydrosoluble Chlorine–Mediated Antimicrobial Photodynamic Therapy on Clinical Parameters and Cytokine Profile in Ligature‐Induced Periodontitis in Dogs

Background: Recently, a hydrosoluble chlorine composed of sodium salts chlorine e6, chlorine p6, and purpurine‐5 has been shown to be a promising photosensitizer in antimicrobial photodynamic therapy (aPDT). The aim of this study is to evaluate the effects of adjunctive application of hydrosoluble chlorine–mediated aPDT compared with scaling and root planing (SRP) alone on clinical parameters and cytokine levels in gingival crevicular fluid of dogs with experimental periodontitis. Methods: Periodontal disease was induced by placing silk ligatures around both maxillary and mandibular teeth. After establishment of attachment loss, full‐mouth SRP was performed in all dogs. One day after SRP, each quadrant randomly received one of the following treatment modalities: hydrosoluble chlorine plus diode laser (wavelength 662 nm, power 100 mW, continuous mode, time of irradiation 20 seconds), hydrosoluble chlorine alone, laser alone, or no adjunctive treatment. The same adjunctive procedure was repeated 1 week later. Clinical parameters including periodontal probing depth, clinical attachment level, and bleeding on probing, as well as crevicular levels of interleukin‐1β and tumor necrosis factor‐α, were evaluated at baseline, at 3 weeks, and at 3 months after treatment. Results: After both 3 weeks and 3 months, all treatment groups showed significant improvement in all clinical and immunologic parameters (P <0.001). No significant differences were found between the four groups with regard to the measured parameters (P >0.05). Conclusion: Based on the results of this study, adjunctive use of hydrosoluble chlorine–mediated aPDT with the current setting has no additional effect on the clinical parameters or proinflammatory cytokine levels in ligature‐induced periodontitis.