The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Robert Knobler - One of the best experts on this subject based on the ideXlab platform.
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real world use of extracorporeal Photopheresis for patients with cutaneous t cell lymphoma in the united states 2010 2015
Journal of Dermatological Treatment, 2020Co-Authors: Youli Ling, Robert Knobler, Xingyue Huang, Ghaith Mitri, Belinda Lovelace, An T Pham, Xin GaoAbstract:AbstractIntroduction: The National Comprehensive Cancer Network and the European Organization for Research and Treatment of Cancer recommend extracorporeal Photopheresis (ECP) as systemic therapy f...
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extracorporeal Photopheresis an overview
Frontiers of Medicine in China, 2018Co-Authors: Ara Cho, Christian Jantschitsch, Robert KnoblerAbstract:Extracorporeal Photopheresis (ECP) has been in clinical use for over three decades after receiving FDA approval for the palliative treatment of the Sezary Syndrome variant of cutaneous T-cell lymphoma (CTCL) in 1988. After the first positive experiences with CTCL, additional indications have been successfully explored including areas such as graft-vs.-host disease (GVHD), scleroderma, and solid organ transplantation. The mechanism of action is still not fully resolved, but important steps in understanding ECP in recent years have been very informative. Originally, the primary hypothesis stated that psoralen and ultraviolet A (UVA) in combination induce apoptosis in the treated immune cells. This view shifted in favor of dendritic cell initiation, modification of the cytokine profile and stimulation of several T-cell lineages, in particular regulatory T-cells. A number of ECP guidelines have been produced to optimize treatment regimens in the clinical context. In CTCL, enough evidence is available for the use of ECP as a first line treatment for Sezary Syndrome (SS), but also as a second line or rescue treatment in therapy-refractory forms of mycosis fungoides (MF). ECP in the treatment of acute and chronic GVHD has shown promising results as second line therapy in steroid-refractory presentations. In solid organ transplantation, ECP has been used to increase tissue tolerance and decrease infections with opportunistic pathogens, attributed to the use of high doses of immunosuppressive medication. Infection with cytomegalovirus (CMV) remains a limiting factor affecting survival in solid organ transplantation and the role of ECP will be discussed in this review. A trend toward prophylactic use of ECP can be observed and may further contribute to improve the outcome in many patients. To further deepen our knowledge of ECP and thus facilitate its use in patients that potentially benefit most from it, future prospective randomized trials are urgently needed in this rapidly growing field. The aim of this review is to (1) introduce the method, (2) give an overview where ECP has shown promising effects and has become an essential part of treatment protocols, and (3) to give recommendations on how to proceed in numerous indications.
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Extracorporeal Photopheresis—An Overview
Frontiers Media S.A., 2018Co-Authors: Ara Cho, Christian Jantschitsch, Robert KnoblerAbstract:Extracorporeal Photopheresis (ECP) has been in clinical use for over three decades after receiving FDA approval for the palliative treatment of the Sézary Syndrome variant of cutaneous T-cell lymphoma (CTCL) in 1988. After the first positive experiences with CTCL, additional indications have been successfully explored including areas such as graft-vs.-host disease (GVHD), scleroderma, and solid organ transplantation. The mechanism of action is still not fully resolved, but important steps in understanding ECP in recent years have been very informative. Originally, the primary hypothesis stated that psoralen and ultraviolet A (UVA) in combination induce apoptosis in the treated immune cells. This view shifted in favor of dendritic cell initiation, modification of the cytokine profile and stimulation of several T-cell lineages, in particular regulatory T-cells. A number of ECP guidelines have been produced to optimize treatment regimens in the clinical context. In CTCL, enough evidence is available for the use of ECP as a first line treatment for Sézary Syndrome (SS), but also as a second line or rescue treatment in therapy-refractory forms of mycosis fungoides (MF). ECP in the treatment of acute and chronic GVHD has shown promising results as second line therapy in steroid-refractory presentations. In solid organ transplantation, ECP has been used to increase tissue tolerance and decrease infections with opportunistic pathogens, attributed to the use of high doses of immunosuppressive medication. Infection with cytomegalovirus (CMV) remains a limiting factor affecting survival in solid organ transplantation and the role of ECP will be discussed in this review. A trend toward prophylactic use of ECP can be observed and may further contribute to improve the outcome in many patients. To further deepen our knowledge of ECP and thus facilitate its use in patients that potentially benefit most from it, future prospective randomized trials are urgently needed in this rapidly growing field. The aim of this review is to (1) introduce the method, (2) give an overview where ECP has shown promising effects and has become an essential part of treatment protocols, and (3) to give recommendations on how to proceed in numerous indications
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extracorporeal Photopheresis in acute and chronic graft versus host disease
Transfusion and Apheresis Science, 2014Co-Authors: H Greinix, Ulrike Just, Nina Worel, Robert KnoblerAbstract:Graft-versus-host disease (GvHD) is a serious complication of allogeneic hematopoietic cell transplantation causing significant morbidity and mortality. Corticosteroids are the established first-line treatment of GvHD. Patients not responding to corticosteroids have a dismal prognosis. Extracorporeal Photopheresis (ECP) has objective activity in the treatment of both acute and chronic corticosteroid-refractory GvHD patients, has an excellent safety profile and is internationally well-established. ECP has been recommended by a significant number of renowned scientific organizations as an efficient treatment option for patients with GvHD. ECP has a proven corticosteroid-sparing effect and favourably impacts on survival and quality of life of responding patients.
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guidelines on the use of extracorporeal Photopheresis
Journal of The European Academy of Dermatology and Venereology, 2014Co-Authors: Robert Knobler, Gosta Berlin, Piergiacomo Calzavarapinton, H Greinix, Peter Jaksch, L Laroche, Johnny Ludvigsson, Pietro Quaglino, Walter Reinisch, Julia ScarisbrickAbstract:Background After the first investigational study on the use of extracorporeal Photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. Materials and methods In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. Results and conclusion These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal Photopheresis based on the available published literature and expert consensus opinion.
H Greinix - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Photopheresis in acute and chronic graft versus host disease
Transfusion and Apheresis Science, 2014Co-Authors: H Greinix, Ulrike Just, Nina Worel, Robert KnoblerAbstract:Graft-versus-host disease (GvHD) is a serious complication of allogeneic hematopoietic cell transplantation causing significant morbidity and mortality. Corticosteroids are the established first-line treatment of GvHD. Patients not responding to corticosteroids have a dismal prognosis. Extracorporeal Photopheresis (ECP) has objective activity in the treatment of both acute and chronic corticosteroid-refractory GvHD patients, has an excellent safety profile and is internationally well-established. ECP has been recommended by a significant number of renowned scientific organizations as an efficient treatment option for patients with GvHD. ECP has a proven corticosteroid-sparing effect and favourably impacts on survival and quality of life of responding patients.
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guidelines on the use of extracorporeal Photopheresis
Journal of The European Academy of Dermatology and Venereology, 2014Co-Authors: Robert Knobler, Gosta Berlin, Piergiacomo Calzavarapinton, H Greinix, Peter Jaksch, L Laroche, Johnny Ludvigsson, Pietro Quaglino, Walter Reinisch, Julia ScarisbrickAbstract:Background After the first investigational study on the use of extracorporeal Photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. Materials and methods In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. Results and conclusion These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal Photopheresis based on the available published literature and expert consensus opinion.
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extracorporeal Photopheresis versus anticytokine therapy as a second line treatment for steroid refractory acute gvhd a multicenter comparative analysis
Biology of Blood and Marrow Transplantation, 2013Co-Authors: Madan Jagasia, H Greinix, Marie Robin, Emma Dasgupta, Ryan Jacobs, Bipin N Savani, Brian G Engelhardt, Adetola A Kassim, Nina Worel, Robert KnoblerAbstract:Abstract The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal Photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P II aGVHD at onset of salvage therapy (HR, 9.4; P
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extracorporeal Photopheresis versus anticytokine therapy as a second line treatment for steroid refractory acute gvhd a multicenter comparative analysis
Biology of Blood and Marrow Transplantation, 2013Co-Authors: Madan Jagasia, H Greinix, Marie Robin, Emma Dasgupta, Ryan Jacobs, Bipin N Savani, Brian G Engelhardt, Adetola A Kassim, Nina Worel, Robert KnoblerAbstract:Abstract The optimal therapy for steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is undefined. We studied patients with SR aGVHD, comparing extracorporeal Photopheresis (ECP; n = 57) and anticytokine therapy (n = 41). In multivariate analyses, ECP, adjusted for steroid dose (odds ratio, 3.42; P = .007), and grade >II aGVHD (odds ratio, 68; P P = .016) in patients with SR grade II aGVHD. Grade >II aGVHD at onset of salvage therapy (HR, 9.4; P P = .011) were associated with inferior survival. These findings require validation in a prospective randomized study.
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extracorporeal Photopheresis past present and future
Journal of The American Academy of Dermatology, 2009Co-Authors: Robert Knobler, Alain H Rook, Mark L Barr, Lars E French, T Schwarz, Daniel R Couriel, Peter Jaksch, Walter Reinisch, James L M Ferrara, H GreinixAbstract:Extracorporeal Photopheresis (ECP) is a leukapheresis-based therapy that uses 8-methoxypsoralen and ultraviolet A irradiation. Used alone or in combination with biological agents, ECP is an established and effective therapy for advanced cutaneous T-cell lymphoma. ECP has also shown promising efficacy in a number of other severe and difficult-to-treat conditions, including systemic sclerosis, graft-versus-host disease, prevention and treatment of rejection in solid organ transplantation, and Crohn disease. Furthermore, the use of ECP in some of these conditions may allow a significant reduction in the use of systemic steroids and other immunosuppressants, reducing long-term morbidity and mortality. The accumulated experience shows ECP to be well tolerated, with no clinically significant side effects. Progress is also being made in the search for understanding of the mechanisms of action of ECP, which will ultimately facilitate improvements in the use of this therapy.
Alain H Rook - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Photopheresis past present and future
Journal of The American Academy of Dermatology, 2009Co-Authors: Robert Knobler, Alain H Rook, Mark L Barr, Lars E French, T Schwarz, Daniel R Couriel, Peter Jaksch, Walter Reinisch, James L M Ferrara, H GreinixAbstract:Extracorporeal Photopheresis (ECP) is a leukapheresis-based therapy that uses 8-methoxypsoralen and ultraviolet A irradiation. Used alone or in combination with biological agents, ECP is an established and effective therapy for advanced cutaneous T-cell lymphoma. ECP has also shown promising efficacy in a number of other severe and difficult-to-treat conditions, including systemic sclerosis, graft-versus-host disease, prevention and treatment of rejection in solid organ transplantation, and Crohn disease. Furthermore, the use of ECP in some of these conditions may allow a significant reduction in the use of systemic steroids and other immunosuppressants, reducing long-term morbidity and mortality. The accumulated experience shows ECP to be well tolerated, with no clinically significant side effects. Progress is also being made in the search for understanding of the mechanisms of action of ECP, which will ultimately facilitate improvements in the use of this therapy.
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a randomized double blind placebo controlled trial of Photopheresis in systemic sclerosis
Journal of The American Academy of Dermatology, 2006Co-Authors: Robert Knobler, Lars E French, Youn H Kim, Emil Bisaccia, Winfried Graninger, Hesam Nahavandi, Frank J Strobl, Edward C Keystone, Marilyn Mehlmauer, Alain H RookAbstract:Background Systemic sclerosis is a multisystemic connective tissue disease with marked involvement of the skin and joints for which few effective evidence based therapies are available. To further investigate the efficacy of extracorporeal photochemotherapy on early aggresive cutaneous disease, a randomized, double-blind, placebo-controlled trial was performed. Objective Our aim was to evaluate the efficacy of Photopheresis in the treatment of patients with systemic sclerosis (scleroderma). Methods This randomized, double-blind, placebo-controlled clinical trial was conducted at 16 investigational sites in the United States, Canada, and Europe. Sixty-four patients with typical clinical and histologic findings of scleroderma, of less than 2 years' duration, were studied. Patients did not receive any other concomitant treatment for scleroderma. Patients were randomized to receive either active or sham Photopheresis treatment on two consecutive days monthly for 12 months. Severity of skin (skin scores assessed in 22 body regions) and joint involvement (60 joints examined for contractures) were assessed on a monthly basis. Results A statistically significant improvement in skin scores as compared with baseline was observed at 6 months (P = .0024) and 12 months (P = .008) among those who received active Photopheresis, but not among those who received sham Photopheresis. Comparison of skin scores between the two study arms did not achieve statistical significance because of the small sample size of the study arms. Joint involvement was also significantly improved after 6 months (P = .002) and 12 months (P = .001) of active Photopheresis when compared with baseline. Limitations The study lacks sufficient statistical power to reveal a significant difference in skin and joint manifestations between the active and sham Photopheresis arms. Conclusion Photopheresis induced significant improvement of skin and joint involvement in patients with scleroderma of recent onset; however, any effect when compared with sham treatment and a possible placebo effect may be modest.
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Photopheresis clinical applications and mechanism of action
The journal of investigative dermatology. Symposium proceedings the Society for Investigative Dermatology Inc. [and] European Society for Dermatologic, 1999Co-Authors: Alain H Rook, Barbara J Denardo, William H Macey, Karen Rebecca Suchin, David M F Kao, Elisa K Yoo, Patricia G Bromely, Yuemei Geng, Jacqueline M Junkinshopkins, Stuart R LessinAbstract:Photopheresis is a leukapheresis-based therapy that utilizes 8-methoxypsoralen and ultraviolet A irradiation. Photopheresis is currently available at approximately 150 medical centers worldwide. Recent evidence suggests that this therapy used as a single agent may signifficantly prolong life, as well as induce a 50%–75% response rate among individuals with advanced cutaneous T cell lymphoma (CTCL). Furthermore, a 20%–25% complete response rate with Photopheresis alone, or in combination with other biologic response modifiers, has been obtained at our institution among patients with Sezary syndrome. These complete responses have been characterized by the complete disappearance of morphologically atypical cells from the skin and blood. The use of sensitive molecular techniques has also confirmed the sustained disappearance of the malignant T cell clone from the blood of patients with complete responses. In addition to the treatment of CTCL, numerous reports indicate that Photopheresis is a potent agent in the therapy of acute allograft rejection among cardiac, lung, and renal transplant recipients. Chronic graft versus host disease also appears to be quite responsive to Photopheresis therapy. Likewise, there may also be a potential role for Photopheresis in the therapy of certain autoimmune diseases that are poorly responsive to conventional therapy. The immunologic basis for the responses of patients with these conditions is likely due to the induction of anticlonotypic immunity directed against pathogenic clones of T lymphocytes. Treatment-induced apoptotic death of pathogenic T cells and activation of antigen presenting cells are postulated to have important effects in this therapeutic process.
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treatment of cutaneous t cell lymphoma with extracorporeal Photopheresis monotherapy and in combination with recombinant interferon alfa a 10 year experience at a single institution
Journal of The American Academy of Dermatology, 1996Co-Authors: Scott L Gottlieb, Jonathan T Wolfe, Floyd E Fox, Barbara J Denardo, William H Macey, Patricia G Bromley, Stuart R Lessin, Alain H RookAbstract:Abstract Background: Extracorporeal Photopheresis is a pheresis-based therapy that permits the direct targeting of psoralen-mediated photochemotherapy to circulating pathogenic T cells. Although Photopheresis is currently used to treat cutaneous T-cell lymphoma (CTCL), limited data are available regarding overall response rates and durability of responses among patients with advanced disease. Furthermore, little is known about the effectiveness and tolerability of combined regimens employing other biologic response modifiers including interferon alfa. Objective: Our purpose was to determine the efficacy of Photopheresis among 41 patients with the clinical and laboratory diagnosis of CTCL; the majority of patients had stage III or IV disease with the presence of circulating malignant T cells. Methods: A retrospective chart review during a 10-year period at a single university hospital was performed for all patients receiving either Photopheresis monotherapy on two consecutive days every 4 weeks (one cycle) and for an additional 12 patients who also received interferon alfa 1.5 to 5 million U subcutaneously three to five times weekly. Results: Thirty-one of 41 patients (76%) were treated for six or more cycles. The remaining 10 were treated with less than six cycles because of rapidly progressing disease ( n = 6), death unrelated to CTCL ( n = 2), or withdrawal from treatment ( n = 1); one of the 10 patients had only received five cycles of treatment but is still receiving therapy. Twenty-eight of the 31 patients treated for six or more cycles received Photopheresis alone. Among the 28, seven patients (25%) had a complete remission, 13 (46%) had a partial remission defined as more than 50% clearing of skin disease, and eight (29%) did not respond to treatment. The presence of Sezary cells in the peripheral blood was associated with a favorable response. Median time to treatment failure was 18 months, whereas median survival from initiation of therapy was 77 months and from the time of diagnosis exceeded 100 months. Nine of these 28 patients went on to receive combination therapy with interferon alfa and, in some cases, other agents. Among these nine patients, five had an enhanced clinical response to the combination therapy compared with treatment with Photopheresis monotherapy. The combined regimen was well tolerated. Conclusion: These results indicate that patients with advanced CTCL can achieve a high response rate for an extended period with Photopheresis and that interferon alfa combined with Photopheresis is a well-tolerated regimen that appears to produce higher response rates than Photopheresis alone.
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extracorporeal photochemotherapy a potentially useful treatment for scleromyxedema
Journal of The American Academy of Dermatology, 1991Co-Authors: Michael Berkson, Gerald Sylvan Lazarus, Marie Ubertibenz, Alain H RookAbstract:Scleromyxedema, a variant of papular mucinosis, is a rare condition that clinically resembles scleroderma. Itis characterized by a lichenoid papular eruption, induration of the skin, and a paraproteinemia of unknown significance. Histologic examination reveals dermal deposition of mucin; proliferation of large, stellate fibroblasts; and fibrosis. Multisystemic manifestations have also been reported. Scleromyxedema is often difficult to treat. One of the most effective therapies is melphalan or a similar alkylating agent but this carries the risk of acute toxicity and malignancy.l-4 We describe a patient who responded to extracorporeal photochemotherapy (Photopheresis) after unsuccessful attempts with other treatment.
Sarah E Dodsonrobinson - One of the best experts on this subject based on the ideXlab platform.
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photophoresis boosts giant planet formation
Astronomy and Astrophysics, 2013Co-Authors: Jens Teiser, Sarah E DodsonrobinsonAbstract:In the core accretion model of giant planet formation, a solid protoplanetary core begins to accrete gas directly from the nebula when its mass reaches ∼5 M⊕. The protoplanet has at most a few million years to reach runaway gas accretion, as young stars lose their gas disks after 10 millionyears at the latest. Yet gas accretion also brings small dust grains entrained in the gas into the planetary atmosphere. Dust accretion creates an optically thick protoplanetary atmosphere that cannot efficiently radiate away the kinetic energy deposited by incoming planetesimals. A dust-rich atmosphere severely slows down atmospheric cooling, contraction, and inflow of new gas, in contradiction to the observed timescales of planet formation. Here we show that photophoresis is a strong mechanism for pushing dust out of the planetary atmosphere due to the momentum exchange between gas and dust grains. The thermal radiation from the heated inner atmosphere and core is sufficient to levitate dust grains and to push them outward. Photophoresis can significantly accelerate the formation of giant planets.
Daniel R Couriel - One of the best experts on this subject based on the ideXlab platform.
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extracorporeal Photopheresis past present and future
Journal of The American Academy of Dermatology, 2009Co-Authors: Robert Knobler, Alain H Rook, Mark L Barr, Lars E French, T Schwarz, Daniel R Couriel, Peter Jaksch, Walter Reinisch, James L M Ferrara, H GreinixAbstract:Extracorporeal Photopheresis (ECP) is a leukapheresis-based therapy that uses 8-methoxypsoralen and ultraviolet A irradiation. Used alone or in combination with biological agents, ECP is an established and effective therapy for advanced cutaneous T-cell lymphoma. ECP has also shown promising efficacy in a number of other severe and difficult-to-treat conditions, including systemic sclerosis, graft-versus-host disease, prevention and treatment of rejection in solid organ transplantation, and Crohn disease. Furthermore, the use of ECP in some of these conditions may allow a significant reduction in the use of systemic steroids and other immunosuppressants, reducing long-term morbidity and mortality. The accumulated experience shows ECP to be well tolerated, with no clinically significant side effects. Progress is also being made in the search for understanding of the mechanisms of action of ECP, which will ultimately facilitate improvements in the use of this therapy.
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extracorporeal Photopheresis for acute and chronic graft versus host disease does it work
Biology of Blood and Marrow Transplantation, 2006Co-Authors: Daniel R Couriel, Chitra Hosing, Rima M Saliba, Elizabeth J Shpall, Paolo Andelini, Uday R Popat, Michele L Donato, Richard E ChamplinAbstract:Abstract Acute and chronic graft-versus-host disease (GVHD) continue to be major limitations to successful hematopoietic stem cell transplantation. A variety of different immunosuppressive and immunomodulating modalities have been tested in chronic GVHD, among them extracorporeal Photopheresis. Photopheresis is currently indicated and Food and Drug Administration–approved for the treatment of skin manifestations of cutaneous T-cell lymphoma, where the response rate has proved to be considerably high. Extracorporeal photochemotherapy has been evaluated in small cohorts of patients with both acute and chronic GVHD. In steroid-refractory acute GVHD of the skin and liver, the reported response rate is more than 60%, especially in patients with less severe forms of the disease. There is more extensive experience in the treatment of chronic GVHD; overall response rates of 50% and higher have been reported in patients with skin, oral, eye, liver, gastrointestinal, or lung involvement. At our center, we analyzed 63 patients who had 3 or fewer lines of immunosuppressant, including tacrolimus and steroids, to avoid the confounding effects of numerous immunosuppressive therapies. The overall response rate was 59% (n = 37), and complete responses were seen in 13 patients. The best responses were observed in GVHD of the skin, liver, oral mucosa, and eye. Our results in chronic GVHD support previous reports of objective responses of skin and visceral GVHD to extracorporeal Photopheresis. All of these results indicate activity of extracorporeal Photopheresis in acute and chronic GVHD, which warrants further evaluation of this therapy in well-designed, prospective, controlled studies.
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extracorporeal Photopheresis therapy in the management of steroid refractory or steroid dependent cutaneous chronic graft versus host disease after allogeneic stem cell transplantation feasibility and results
Bone Marrow Transplantation, 2003Co-Authors: N Apisarnthanarax, Daniel R Couriel, Chitra Hosing, Richard E Champlin, M Donato, Martin Korbling, James Gajewski, Sergio Giralt, Issa F Khouri, Madeleine DuvicAbstract:Extracorporeal Photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: feasibility and results