Hopkins Health

Photopheresis: The Curative Power of Ultraviolet Light

Caught early, cutaneous T-cell lymphomas can be contained by applying medications to the skin. But detected late, these malignancies demand more-potent treatments with toxic side effects. In a novel type of photochemotherapy that uses ultraviolet light, called PUVA, cancerous cells are destroyed by a drug called psoralen, which is activated when the patient’s skin is exposed to ultraviolet rays. But because PUVA also subjects the skin to significant radiation, it can lead to skin cancers like basal and squamous cell carcinoma.

“Unfortunately, sometimes the treatment can be worse than the disease,” says Daniel Sauder, M.D., chairman of the Department of Dermatology.

Now, under the leadership of Eric Vonderheid, M.D., and using a variation of the PUVA approach, the department is offering a new therapy for late-stage cutaneous T-cell lymphoma—and some other diseases—without the toxic side effects. Called photopheresis, the treatment works by first circulating the patient’s blood through a device that separates the T cells from the red cells and plasma. As in PUVA, these T cells then are radiated with ultraviolet light, altering them in a way that causes them to be recognized and attacked by the patient’s own immune system as they re-enter the body.

“You’re essentially vaccinating against these T cells by using ultraviolet light to alter the cells in such a way as to stimulate a host-immune response against them,” explains Sauder.

The results? While the median survival for untreated late-stage cutaneous T-cell lymphoma is less than a year, initial studies show that photopheresis adds months to years to that statistic. “Certainly there is a significant prolongation of life,” Sauder says.

Additionally, notes Sauder, because the treatment bypasses the skin to get to the cancerous cells, it avoids toxic side effects: “You’re doing PUVA without the problems associated with PUVA.”

Perhaps even more exciting, adds Sauder, is the use of photopheresis in organ transplants and in the treatment of graft vs. host disease. For instance, photopheresis has proven extremely effective in reducing the reliance on immunosuppressive drugs to prevent immune rejection in transplants. It is also being used in autoimmune disorders like rheumatoid arthritis and scleroderma.