Background: Extracorporeal photopheresis is a therapy based on the induction of apoptosis to cells harvested from peripheral blood, followed by direct retransfusion. Currently, there are two approaches: inline procedures, where cell harvesting, 8-methoxypsoralen (8-MOP) incubation, and UV irradiation is performed with a single device, and offline procedures, with collection in one device, followed by 8-MOP incubation/UV irradiation using a second device. Study Design and Methods: In a prospective crossover study, we compared an inline (Cellex, Therakos) with an established offline procedure (Optia, Terumo, and MacoGenic G2, Macopharma) in 6 patients, focusing on cell composition and apoptosis induction after 24 h. In total, 32 photopheresis treatments per device were performed. Results: We observed an overall 2-fold higher number of apoptotic “target” cells for each patient with offline treatment. All yields were stratified per patient. Yields were compared as ratio offline/inline for CD3+ (2.5-fold), CD4+ (2-fold), CD8+ (2.8-fold), CD56+ (2.8-fold), CD19+ (1.8-fold), CD15+ (0.5-fold), and CD14+ (2.2-fold) cells. Apoptosis induction was measured after 24 h with Annexin V/7-AAD for early and late apoptosis rates of CD3+ (CD4+, CD8+) and CD56+ cells. CD3+ cells of the inline treatment had an average of 88% (26% early, 62% late) of apoptotic cells compared to 75% (34% early, 41% late) in the offline treatment. Procedure duration ranged from 80 to 100 min inline, with a maximum of 1,500 mL processed blood, and 125–140 min offline, with at least 3,000 mL processed blood, depending on blood flow. Average hematocrit levels of the products were 2.7% inline versus 1.7% offline. Conclusions: The offline procedure, as established in our department, provides more apoptotic cells for treatment. The increased number of mononuclear cells collected outweighs a slightly reduced apoptosis rate after 24 h in comparison to the inline procedure. Besides this, the final decision for one or the other procedure has to take into account additional aspects, such as peripheral white blood cell count, hematocrit, and weight of the patient, required before apheresis, extracorporeal volume, and, last but not least, overall costs. The final criterion, however, has to be the reported clinical efficacy of the system applied.

中文翻译：

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离线是否优于在线治疗：对体外光置换术的调查

背景：体外光照疗法是一种基于诱导从外周血中采集的细胞凋亡，然后直接再输血的疗法。目前，有两种方法：在线程序，其中细胞收获、8-甲氧基补骨脂素 (8-MOP) 孵育和紫外线照射使用单个设备进行，以及离线程序，在一个设备中收集，然后进行 8-MOP 孵育/使用第二个装置的紫外线照射。研究设. 每个装置总共进行了 32 次光分离处理。结果：我们观察到每位接受离线治疗的患者的凋亡“靶”细胞数量总体高出 2 倍。所有产量均按患者分层。CD3+（2.5 倍）、CD4+（2 倍）、CD8+（2.8 倍）、CD56+（2.8 倍）、CD19+（1.8 倍）、CD15+（0.5 倍）的产量以离线/在线比率进行比较, 和 CD14+ (2.2-fold) 细胞。用 Annexin V/7-AAD 在 24 小时后测量 CD3+（CD4+、CD8+）和 CD56+ 细胞的早期和晚期凋亡率的细胞凋亡诱导。与离线处理的 75%（早期 34%，晚期 41%）相比，在线处理的 CD3+ 细胞平均有 88%（早期 26%，晚期 62%）的凋亡细胞。手术持续时间从在线 80 到 100 分钟不等，最多处理 1,500 mL 的血液，离线 125-140 分钟，至少处理 3,000 mL 的血液，具体取决于血流。产品的平均血细胞比容水平在线为 2.7%，离线为 1.7%。结论：我科建立的离线程序为治疗提供了更多的凋亡细胞。与内联程序相比，收集的单核细胞数量增加超过了 24 小时后略微降低的细胞凋亡率。除此之外，对于一个或另一个程序的最终决定必须考虑其他方面，例如外周血白细胞计数、血细胞比容和患者体重，在单采术前需要、体外容量，以及最后但并非最不重要的，总成本。然而，最终标准必须是所应用系统的临床疗效报告。为治疗提供更多的凋亡细胞。与内联程序相比，收集的单核细胞数量增加超过了 24 小时后略微降低的细胞凋亡率。除此之外，对于一个或另一个程序的最终决定必须考虑其他方面，例如外周血白细胞计数、血细胞比容和患者体重，在单采术前需要、体外容量，以及最后但并非最不重要的，总成本。然而，最终标准必须是所应用系统的临床疗效报告。为治疗提供更多的凋亡细胞。与内联程序相比，收集的单核细胞数量增加超过了 24 小时后略微降低的细胞凋亡率。除此之外，对于一个或另一个程序的最终决定必须考虑其他方面，例如外周血白细胞计数、血细胞比容和患者体重，在单采术前需要、体外容量，以及最后但并非最不重要的，总成本。然而，最终标准必须是所应用系统的临床疗效报告。例如外周血白细胞计数、血细胞比容和患者体重、单采术前所需的、体外容量，以及最后但并非最不重要的总成本。然而，最终标准必须是所应用系统的临床疗效报告。例如外周血白细胞计数、血细胞比容和患者体重、单采术前所需的、体外容量，以及最后但并非最不重要的总成本。然而，最终标准必须是所应用系统的临床疗效报告。