Extrakorporale Photopherese in der Dermatologie: ein Update

Zusammenfassung

Das Grundprinzip der extrakorporalen Photopherese (ECP) besteht in der Isolierung von kernhaltigen Blutzellen durch Zentrifugalkraft (Leukapherese), Behandlung des Apheresates mit 8-Methoxypsoralen, Bestrahlung mit ultraviolettem Licht und Reinfusion. Diese Behandlung wurde vor 30 Jahren zunächst für die Therapie des kutanen T-Zell-Lymphoms entwickelt. Da die ECP eine Modulation der durch T-Zellen vermittelten Immunität bewirkt, wurde sie später auch in Indikationen, die auf einer Fehlregulation der zellulären Abwehr beruhen, etabliert. In der Dermatologie zählen hierzu v. a. die akute und chronische Graft-versus-Host-Krankheit, die systemische Sklerose, die therapierefraktäre atopische Dermatitis und bestimmte blasenbildende Autoimmundermatosen. Die ECP kann als wirksame und sichere Therapieoption für diese teils lebensbedrohenden, schmerzhaften und psychisch belastenden Hautkrankheiten angesehen werden. In den meisten Fällen erlaubt die ECP eine Dosisreduktion von Kortikosteroiden. In manchen Indikationen fehlen jedoch noch die für eine wissenschaftlich fundierte Bewertung notwendigen randomisierten Vergleichsstudien.

Abstract

The principal steps of extracorporeal photopheresis (ECP) include separation of leucocytes (buffy coat) through centrifugal force (leukapheresis), treatment of the apheresate with 8-methoxypsoralen, radiation with ultraviolet light and reinfusion. Thirty years ago this treatment modality was developed for the therapy of erythrodermic variants of cutaneous T cell lymphoma. As ECP results in the modulation of T cell mediated immunity, it was also later established in indications which are associated with a dysregulation of the cellular immune response. Indications in dermatology particularly include acute and chronic graft-versus-host disease, systemic sclerosis, recalcitrant atopic dermatitis and certain bullous autoimmune dermatoses. ECP can be regarded as a valuable and safe treatment option in these potentially life-threatening, painful and emotionally burdening conditions. In most cases, corticosteroids can be reduced. However, in some indications the beneficial effects of ECP have still not been confirmed in randomized comparative studies.

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