Yale Dermatology Photopheresis Unit

girardi2_smMichael Girardi, MD
Professor of Dermatology

Director, Photopheresis Unit
Michael Girardi, MD
Professor of Dermatology

Director, Photopheresis Unit


Staff

The Photopheresis Center is under the direction of Michael Girardi, MD, Robert Tigelaar, MD, Jaehyuk Choi, MD, Kacie Carlson, PA-C, and Inger Christensen, RN, the clinical coordinator. Maureen Alvarez, RN and Susan Kelly, RN round out the staff of nurses who administer photopheresis to patients on a daily outpatient basis. The unit performs close to 1000 treatments per year.

Cutaneous T-cell lymphoma

When it was first described in the nineteenth century, cutaneous T-cell lymphoma looked like a fungus infection of the skin with large, mushroom-like protuberances, so it was called "mycosis fungoides." In the 1980s, research by Dr. Richard Edelson, Chairman of the Department of Dermatology at the Yale School of Medicine, proved that the disease was caused by a malignancy of the lymphocytes, and he renamed it cutaneous T-cell lymphoma (or CTCL). CTCL is currently a central research interest of the Department of Dermatology and the focus of a well-organized inter-disciplinary group of scientists and clinicians at The Yale Cancer Center.

Photopheresis has become an important treatment option for patients with advanced CTCL who do not respond to standard treatments.  It is often used with other treatments to stimulate the immune system.

CTCL affects more than 10,000 people every year, which makes it the most common form of cancer of white blood cells of adults. At Yale, nearly 250 new CTCL patients are seen annually. When CTCL is untreated, the cancerous lymphocytes of CTCL can spread to the blood and to other internal organs and distant skin sites. In the early stage, Yale physicians treat CTCL and utilize every available modality including electron beam radiation, phototherapy, nitrogen mustard, bexarotene, interferon and vorinostat. Photopheresis, invented by Dr. Edelson in the 1980s, is often called "extracorporeal photoimmunotherapy."

Photopheresis - Extracorporeal Photoimmunotherapy

The method of photopheresis is simple: the patient is connected to a machine that withdraws a quantity of blood in a manner similar to kidney dialysis. The machine, which is the size of a dishwasher, separates the blood into red blood cells, white blood cells, and plasma. The white blood cells and part of the plasma are mixed with a light activatable drug called 8-methoxypsoralen (8-MOP). The blood and 8-MOP are irradiated with ultraviolet light within the machine before being combined with the other native blood components and returned to the patient.

The treated and untreated blood is returned to the patient. After treatments at weekly or monthly intervals, responders (25-40% of all subjects) begin to show a response after 3 to 6 months of therapy. Because only a small portion of the patient's malignant cells are ever treated it has been assumed that an immune response has been induced. Our department is investigating mechanisms of photopheresis and genetic alterations in CTCL to try to improve treatment options.

When the new knowledge gained from current Photopheresis research is fully translated into clinical practice, it is conceivable that people with other immune illnesses may benefit. Preliminary tests in a range of studies from around the world suggest that photopheresis is beneficial in "T-cell mediated autoimmune diseases" such as pemphigus, lupus erythematosus, multiple sclerosis, rheumatoid arthritis and scleroderma. In particular, organ transplant rejection (including heart, lung, kidney and liver) and graft-versus-host-disease (GVHD) are two major categories of disease that have been targeted with Photopheresis treatment.