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      Guidelines on the use of extracorporeal photopheresis

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          Abstract

          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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          Most cited references277

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          The ISCL/EORTC recommends revisions to the Mycosis Fungoides Cooperative Group classification and staging system for cutaneous T-cell lymphoma (CTCL). These revisions are made to incorporate advances related to tumor cell biology and diagnostic techniques as pertains to mycosis fungoides (MF) and Sézary syndrome (SS) since the 1979 publication of the original guidelines, to clarify certain variables that currently impede effective interinstitution and interinvestigator communication and/or the development of standardized clinical trials in MF and SS, and to provide a platform for tracking other variables of potential prognostic significance. Moreover, given the difference in prognosis and clinical characteristics of the non-MF/non-SS subtypes of cutaneous lymphoma, this revision pertains specifically to MF and SS. The evidence supporting the revisions is discussed as well as recommendations for evaluation and staging procedures based on these revisions.
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            Homeostasis and inflammation in the intestine.

            The gut is home to our largest collection of microbes. The ability of the immune system to coevolve with the microbiota during postnatal life allows the host and microbiota to coexist in a mutually beneficial relationship. Failure to achieve or maintain equilibrium between a host and its microbiota has negative consequences for both intestinal and systemic health. In this Review, we consider the many cellular and molecular methods by which inflammatory responses are regulated to maintain intestinal homeostasis and the disease states that can ensue when this balance is lost. 2010 Elsevier Inc. All rights reserved.
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              Insulin needs after CD3-antibody therapy in new-onset type 1 diabetes.

              Type 1 diabetes mellitus is a T-cell-mediated autoimmune disease that leads to a major loss of insulin-secreting beta cells. The further decline of beta-cell function after clinical onset might be prevented by treatment with CD3 monoclonal antibodies, as suggested by the results of a phase 1 study. To provide proof of this therapeutic principle at the metabolic level, we initiated a phase 2 placebo-controlled trial with a humanized antibody, an aglycosylated human IgG1 antibody directed against CD3 (ChAglyCD3). In a multicenter study, 80 patients with new-onset type 1 diabetes were randomly assigned to receive placebo or ChAglyCD3 for six consecutive days. Patients were followed for 18 months, during which their daily insulin needs and residual beta-cell function were assessed according to glucose-clamp-induced C-peptide release before and after the administration of glucagon. At 6, 12, and 18 months, residual beta-cell function was better maintained with ChAglyCD3 than with placebo. The insulin dose increased in the placebo group but not in the ChAglyCD3 group. This effect of ChAglyCD3 was most pronounced among patients with initial residual beta-cell function at or above the 50th percentile of the 80 patients. In this subgroup, the mean insulin dose at 18 months was 0.22 IU per kilogram of body weight per day with ChAglyCD3, as compared with 0.61 IU per kilogram with placebo (P<0.001). In this subgroup, 12 of 16 patients who received ChAglyCD3 (75 percent) received minimal doses of insulin (< or =0.25 IU per kilogram per day) as compared with none of the 21 patients who received placebo. Administration of ChAglyCD3 was associated with a moderate "flu-like" syndrome and transient symptoms of Epstein-Barr viral mononucleosis. Short-term treatment with CD3 antibody preserves residual beta-cell function for at least 18 months in patients with recent-onset type 1 diabetes. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Journal
                J Eur Acad Dermatol Venereol
                J Eur Acad Dermatol Venereol
                jdv
                Journal of the European Academy of Dermatology and Venereology
                BlackWell Publishing Ltd (Oxford, UK )
                0926-9959
                1468-3083
                January 2014
                19 December 2013
                : 28
                : Suppl 1
                : 1-37
                Affiliations
                [1 ]Department of Dermatology, Medical University of Vienna Vienna, Austria
                [2 ]Department of Clinical Immunology & Transfusion Medicine, University Hospital Linköping, Sweden
                [3 ]Department of Dermatology, University Hospital Spedali Civili Brescia, Italy
                [4 ]Department of Internal Medicine I/Bone Marrow Transplantation, Medical University of Vienna Vienna, Austria
                [5 ]Department of Thoracic Surgery, Medical University of Vienna Vienna, Austria
                [6 ]Department of Dermatology, Avicenne Hospital Bobigny, France
                [7 ]Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University Linköping, Sweden
                [8 ]Dermatology Clinic, Department of Medical Sciences, University of Turin Turin, Italy
                [9 ]Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna Vienna, Austria
                [10 ]Department of Dermatology, University Hospital Birmingham, UK
                [11 ]Department of Dermatology and Allergology, University Hospital Schleswig-Holstein Kiel, Germany
                [12 ]Department of Dermatology, Medical University of Graz Graz, Austria
                [13 ]Department of Dermatology, Charles University in Prague Prague, Czech Republic
                [14 ]Department of Dermatology, HELIOS Klinikum Krefeld Krefeld, Germany
                [15 ]Department of Dermatology, Saint Louis Hospital, Université Paris 7 Sorbonne Paris Cité, INSERM U976 Paris, France
                [16 ]Department of Surgery, University of Southern California Los Angeles, USA
                [17 ]Department of Haematology and Oncology, University of Strasbourg Strasbourg, France
                [18 ]Department of Dermatology, University Medical Centre Freiburg Freiburg, Germany
                [19 ]Department of Skin Cancer, Nantes University Hospital Nantes, France
                [20 ]Department of Dermatology, University of Heidelberg Heidelberg, Germany
                [21 ]Department of Dermatology, Zurich University Hospital Zurich, Switzerland
                [22 ]Department of Dermatology, Bispebjerg Hospital Copenhagen, Denmark
                [23 ]Department of Dermatology and Venereology, Otto-von-Guericke University Magdeburg, Germany
                [24 ]Department of Dermatology and Allergology, University Hospital Marburg Marburg, Germany
                [25 ]Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center Dessau, Germany
                [26 ]Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Ruprecht-Karls University of Heidelberg Mannheim, Germany
                [27 ]Department of Dermatology, University of Münster Münster, Germany
                [28 ]Department of Dermatology, Athens University School of Medicine, ΑΤΤΙΚΟΝ General University Hospital Athens, Greece
                [29 ]Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital Helsinki, Finland
                [30 ]Department of Dermatology, Johannes Wesling Medical Centre Minden, Germany
                [31 ]Department of Dermatology, Charité University Hospital Berlin, Germany
                [32 ]Department of Dermatology and Allergology, Charité University Hospital Berlin, Germany
                [33 ]Division of Dermatology, Vanderbilt University School of Medicine Nashville, TN, USA
                [34 ]Department of Dermatology, Venereology and Allergology, University Duisburg-Essen Essen, Germany
                Author notes
                *Correspondence: Robert Knobler., E-mail: robert.knobler@ 123456meduniwien.ac.at
                Article
                10.1111/jdv.12311
                4291097
                24354653
                4b66b03a-5cf0-4a1c-b887-508c551433b2
                Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 07 October 2013
                Categories
                Guidelines on the Use of Extracorporeal Photopheresis. Publication of This Supplement was Supported by a Grant From the European Dermatology Forum

                Dermatology
                Dermatology

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