Factual reflections and recommendations on extracorporeal photopheresis in pediatrics

One of the biggest challenges in evaluating available literature on extracorporeal photopheresis (ECP) practices in pediatric patients is the marked heterogeneity of approaches to the patient evaluation, procedural aspects and apheresis product analysis. These issues are most relevant in ECP management in children with graft versus host disease (GVHD) after hematopoietic stem cell transplantation. Extracorporeal photopheresis in pediatric patients is considered relatively safe with few adverse effects reported from retrospective or observational studies. Careful patient eligibility assessment for ECP procedures and close monitoring while on ECP therapy is still required by transfusion medicine and pediatric specialists. Particular attention is necessary considering the rapidly changing clinical status of children with graft versus host disease after hematopoietic stem cell transplantation, focusing on hemodynamic compromise, hematologic and metabolic disturbances. This is a review of the approaches to some of the safety issues in long-term ECP therapy in low-weight pediatric patients.