Extracorporeal photopheresis alone and with interferon-alpha(2a) in chronic hepatitis C patients who failed previous interferon therapy

Extracorporeal photopheresis (ECP) is approved for treatment of cutaneous, T-cell lymphoma. Evidence suggests that ECP can induce an immune response a gainst tumor antigens expressed by malignant T lymphocytes, We theorized th at if HCV-infected PBMCs express viral antigens, ECP could demonstrate anti viral activity by eliciting an immune response against these antigens. Fift een cirrhotic patients with genotype-1 HCV, who had previously relapsed or not responded to interferon-alpha (IFN-alpha) therapy were stratified by th eir HCV RNA titer into one of three treatment groups: (1) ECP alone, (2) EC P + 3 MIU IFN-alpha(2a) subcutaneously three times a week and (3) ECP + 6 M IU IFN-alpha(2a) subcutaneously three times a week. All patients received t reatment for 24 weeks. Group 1 had no significant decrease in HCV RNA, Two patients in group 2 had undetectable HCV RNA at the end of treatment. One p atient in group 3 had undetectable HCV RNA at the end of treatment, However , HCV RNA was detected in all three patients during follow-up. ECP alone or with IFN-alpha was well tolerated. ECP alone demonstrated no clear antivir al activity. The combination of ECP and IFN-alpha resulted in an end-of-tre atment response (ETR) in three of 10 patients. All responders had eliminati on of serum HCV RNA by three months, although no patient had a sustained re sponse. More intensive therapy for a longer duration may result in sustaine d responses. A multicenter trial is now underway.