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The potential association between extracorporeal photopheresis and thrombosis

Bone Marrow Transplantation volume 59, pages 270–273 (2024)Cite this article

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Extracorporeal photopheresis (ECP) is a treatment modality whereby buffy coat elements, including mononuclear cells, are removed from the circulation via an apheresis device, treated with the psoralen photosensitizer 9-methoxy-7H-furo[3,2-g][1]-benzopyran7-one (methoxsalen/UVADEX®) [1], exposed to ultraviolet A (UVA) light, and reinfused to the patient. Psoralen exposed to UVA results crosslinks DNA pyrimidine bases, resulting in apoptosis of nucleated cells and immunomodulatory effects [2]. Heparin is typically used to prevent thrombus formation in the circuit. ECP was developed approximately 40 years ago to treat refractory cutaneous T-cell lymphoma (CTCL), which remains the only United States (US) Food and Drug Administration (FDA)-approved application for ECP [3]. However, the indications for ECP have expanded to include graft-versus-host disease (GVHD), cellular-mediated cardiac transplant rejection, and chronic lung allograft dysfunction/bronchiolitis obliterans syndrome [4, 5]. ECP has also been incorporated into secondary treatment regimens for patients with T-cell mediated dermatologic conditions (e.g., systemic sclerosis, atopic dermatitis, pemphigus vulgaris, psoriasis) if refractory to first line immunosuppression [6,7,8].

ECP is considered safe, particularly when compared to systemic medications that are often required for these disorders. Adverse effects of ECP are typically mild [9], and include fever, sun-sensitivity (including premature aging and burns), volume shifts from the extracorporeal circuit, and electrolyte disturbances (e.g. hypocalcemia) if citrate is used as the anticoagulant [10]. Severe side effects, such as bleeding or heparin-induced thrombocytopenia, are unusual.

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All original data are available in this manuscript.

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Authors and Affiliations

  1. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Jeremy W. Jacobs

  2. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Brian D. Adkins

  3. Department of Dermatology, Mayo Clinic, Rocester, MN, USA

    Lorin A. Bibb

  4. Department of Pathology, City of Hope National Medical Center, Irvine, CA, USA

    Jennifer S. Woo

  5. Department of Pathology, University of California San Diego, La Jolla, CA, USA

    Elizabeth S. Allen & Laura D. Stephens

  6. Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA

    Thomas C. Binns

  7. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Evan M. Bloch

  8. Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    Garrett S. Booth

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  1. Jeremy W. Jacobs
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Contributions

JWJ and GSB performed the research, drafted the manuscript, and approved the final version. BDA, LAB, JSW, ESA, LDS, TCB, and EMB revised the manuscript and approved the final version.

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Correspondence to Jeremy W. Jacobs.

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Jacobs, J.W., Adkins, B.D., Bibb, L.A. et al. The potential association between extracorporeal photopheresis and thrombosis. Bone Marrow Transplant 59, 270–273 (2024). https://doi.org/10.1038/s41409-023-02153-7

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  • DOI: https://doi.org/10.1038/s41409-023-02153-7

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