Extracorporeal photopheresis practice patterns: An international survey by the ASFA ECP subcommittee

• Published in: Journal of clinical apheresis Vol. 32; no. 4; pp. 215 - 223
• Main Authors: Dunbar, Nancy M., Raval, Jay S., Johnson, Andrew, Abikoff, Cori M., Adamski, Jill, Cooling, Laura L., Grossman, Brenda, Kim, Haewon C., Marques, Marisa B., Morgan, Shanna, Schmidt, Amy E., Sloan, Steven R., Su, Leon L., Szczepiorkowski, Zbigniew M., West, F. Bernadette, Wong, Edward, Schneiderman, Jennifer
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-08-2017
• Subjects: Apheresis; extracorporeal photopheresis; Graft vs Host Disease - therapy; Humans; Lymphoma, T-Cell, Cutaneous - therapy; Patient Selection; Photodynamic therapy; Photopheresis - methods; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - trends; Quality Assurance, Health Care; Skin Transplantation - adverse effects; Surveys and Questionnaires; therapeutic apheresis; therapeutic apheresis; extracorporeal photopheresis; apheresis
• ISSN: 0733-2459; 1098-1101
• DOI: 10.1002/jca.21486

Background
Although many apheresis centers offer extracorporeal photopheresis (ECP), little is known about current treatment practices.
Methods
An electronic survey was distributed to assess ECP practice internationally.
Results
Of 251 responses, 137 met criteria for analysis. Most respondents were from North America (80%). Nurses perform ECP at most centers (84%) and the majority of centers treat adults only (52%). Most centers treat fewer than 50 patients/year (83%) and perform fewer than 300 procedures/year (70%). Closed system devices (XTS and/or Cellex) are used to perform ECP at most centers (96%). The most common indications for ECP are acute/chronic skin graft versus host disease (89%) and cutaneous T‐cell lymphoma (63%). The typical wait time for ECP treatment is less than 2 weeks (91%). Most centers do not routinely perform quality control assessment of the collected product (66%). There are device‐specific differences in treatment parameters. For example, XTS users more frequently have a minimum weight limit (P = 0.003) and use laboratory parameters to determine eligibility for treatment (P = 0.03). Regardless of device used, the majority of centers assess the clinical status of the patient before each procedure. Greater than 50% of respondents would defer treatment for hemodynamic instability due to active sepsis or heart failure, positive blood culture in the past 24 h or current fever.
Conclusion
This survey based study describes current ECP practices. Further research to provide evidence for optimal standardization of patient qualifications, procedure parameters and product quality assessment is recommended.