A new treatment to avoid rejection in patients who have undergone a bone marrow transplant has been active for a few days at Simt, the Immunohematology and Transfusion Medicine service, of the Perrino hospital in Brindisi, directed by Antonella Miccoli.
ECP, or extracorporeal photopheresis, is a light-activated therapy performed outside the body on temporarily separated blood cells. It is used for the treatment of a series of immune-mediated diseases, including GvHD, Graft versus Host Disease or graft versus host disease.
“Extracorporeal photochemotherapy, in the acronym EPC or photopheresis – explains Antonella Miccoli – is an innovative immunotherapeutic method based on apheresis which consists in the extracorporeal exposure of peripheral blood mononuclear leukocytes to ultraviolet A radiation in the presence of methoxalene, a substance which also found in nature in some plants.”
In summary, the blood taken from patients transplanted with the classic method is separated to isolate the leukocytes that could potentially cause GvHD: once isolated from the other elements, the leukocytes are inserted into the new instrument made available by the Brindisi Local Health Authority at the Perrino Simt which photoinhibits its action, making its immediate reinfusion safe in the subject.
“The one in use in Brindisi – continues Miccoli – is the so-called “offline technique” or two-phase method and includes cell separation with the standard technique as the first step. The apheretic product is transferred to a disposable device to which 8-MOP, methoxalene, is added and is irradiated. After irradiation, transfusion of the treated cells is performed manually using a standard transfusion set. The EPC will be used, in particular, for patients in the Hematology Unit undergoing allogeneic haematopoietic stem cell transplantation. This procedure is now fundamental and indifferent in patients with Graft versus acute refractory host disease and in patients with Graft versus chronic host disease as per the GITMO (Italian Bone Marrow Transplantation Group) and EBMT (European Blood and Marrow Transplation) guidelines”.
EPC is a safe and effective treatment for patients with chronic GvHD with steroid-sparing capabilities; in the treatment of acute GvHD, compared to other immunosuppressive therapies, EPC has an excellent safety profile with limited toxicity problems, no increase in viral reactivations and no documented interactions with other drugs.
“I thank the strategic management of the ASL – concludes Miccoli – for having equipped the Center with this new machine which expands the range of treatments that we can offer to patients in the province of Brindisi who until now had to turn elsewhere to find safe, effective and all-round solutions. ‘avant-garde’.
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