Extracorporeal photopheresis

Extracorporeal photopheresis (ECP) is a cell therapy technique consisting in removing mononuclear cells from the patient’s blood by apheresis, exposing them ex vivo to ultraviolet light in the presence of a photoactivatable substrate and then reinjecting them into the patient. This procedure triggers an immune reaction that modulates the number and function of T lymphocytes and other immune system cells, hence the clinical effect. ECP can be considered a form of immunomodulatory therapy, whose beneficial effects in patients with cutaneous T-cell lymphomas (CTCLs) have been reported since 1987. Since then, other diseases associated with T lymphocyte dysfunctions have been the subject of clinical studies of ECP. In 2015, the three main indications were CTCLs, graft-versus-host disease (GVHD) in the context of allogenic hematopoietic stem cell transplantation (HSCT), and solid-organ transplant rejection.

Since ECP is a highly specialized medical procedure, the Ministère de la Santé et des Services sociaux (MSSS) authorized, in 2010, the creation of a Québec ECP program. The program was set up jointly by Hôpital Maisonneuve-Rosemont (HMR) and the McGill University Health Centre (MUHC). Subsequently, other Quebec hospitals informed the MSSS of their desire to offer ECP as well. In order to reply to these requests objectively, the Direction générale de cancérologie (DGC) asked, in January 2014, the Institut national d’excellence en santé et en services sociaux (INESSS) to examine the scientific evidence regarding the efficacy, safety, and organizational and economic aspects of ECP as it pertains to the three main indications for this treatment modality.