Extracorporeal photochemotherapy - Present and future

Extracorporeal photochemotherapy (ECP) was introduced by Edelson and co-wor kers in 1985. Since then the therapy, though still controversial in specifi c indications, has received wide acceptance and is presently been used in o ver 160 centers in Europe and the U.S.A. for a number of important dermatol ogical and non-dermatological indications. Convincing data in the past few years has documented that ECP is associated with a very low side-effect pro file. As of 2000 ECP continues to be used in the treatment of cutaneous T-c ell lymphoma, alone or in combination with other treatment modalities, and increasingly in the management of additional T-cell mediated diseases, acut e as well as chronic Graft versus Host Disease (GvHD) after allogeneic bone marrow transplantation in particular. ECP has also been shown to play an i mportant role in the treatment of acute as well as chronic allograft reject ion, in renal, lung, and cardiac transplant recipients and lately steroid r efractory inflammatory bowel disease. A number of mechanisms for its effica cy have been proposed whereby at present induction of anticlonotypic immuni ty directed against pathogenic clones of T lymphocytes may be an important concept. Treatment related apoptotic death of involved T cells and concurre nt activation of antigen presenting cells may also closely relate to mechan isms associated with this therapy.