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All other remaining blood components are also returned to the patient. The purpose of this procedure is immunomodulation. The treated leukocytes, specifically T\u2010cells, are returned to the patient's circulation and will induce cytotoxicity and reduce proliferation of new T\u2010cells. In the United States, ECP was initially approved for the treatment of cutaneous T\u2010cell lymphoma by the US Food and Drug Administration in the late 1980s. Since that time, it has been used as an \u201coff\u2010label\u201d therapy to treat several other autoimmune diseases in the United States and even more extensively in Europe and Asia. The following review is limited to the current clinical use of ECP in cutaneous T\u2010cell lymphoma, Crohn's disease, systemic sclerosis, graft versus host disease, and emerging data on nephrogenic systemic fibrosis. J. Clin. 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