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Mechanism of action of extracorporeal photochemotherapy in chronic graft‐versus‐host disease

Article first published online: 04 Jun 2004
DOI: 10.1111/j.1365-2133.2004.05918.x

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Summary

Chronic graft‐versus‐host disease (GvHD) affects 50% of long‐term bone marrow transplant survivors and remains a cause of major long‐term morbidity in these patients despite aggressive therapy. Extracorporeal photochemotherapy (ECP), considered as an effective treatment for patients with erythrodermic cutaneous T‐cell lymphoma (CTCL), has recently been used successfully in the treatment of GvHD. One of the most intriguing aspects of ECP is its ability to induce two apparently opposite effects: activation of the immune system against neoplastic cells (as in CTCL) and downregulation of the activity of T‐cell clones in autoimmune diseases (as in systemic sclerosis, systemic lupus erythematosus and pemphigus vulgaris) and autoallogeneic immune responses (as in GvHD and allograft rejection). Only a better and more complete understanding of the various mechanisms involved will enable this interesting new therapy to be made more effective and selective.

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