Extracorporeal Photopheresis (ECP)

Author: Marisa Healy, BSN, RN
Content Contributor: Alain H. Rook, MD
Last Reviewed: November 13, 2023

What is extracorporeal photopheresis?

Extracorporeal photopheresis (ECP), also called simply "photopheresis," extracorporeal photoimmune therapy, or photochemotherapy is a treatment that uses your white blood cells and a medication that makes your white blood cells more sensitive to light, which helps your immune system fight certain diseases.

ECP can rev up your immune system to fight certain diseases, like cancer. ECP can also “shut off” or “reset” your immune system so that it does not reject your new bone marrow or heart transplant. Your provider will tell you why you will be getting ECP.

What does extracorporeal photopheresis treat?

Your provider may suggest ECP if:

  • You have a type of blood cancer called cutaneous T-Cell lymphoma (CTCL).
    • To treat CTCL, ECP helps your immune system kill cancer cells.
  • You have graft-versus-host disease (GVH or GVHD) after a stem cell or bone marrow transplant.
    • ECP seems to increase the number of regulatory T-cells in your body, causing less inflammation in your body. ECP also seems to help get rid of T-cells that cause GVH.
  • Your body is rejecting an organ transplant.
    • To treat organ rejection, ECP is done to stop T-lymphocyte cells from attacking your new organ.

ECP may be used for other reasons. If ECP is part of your treatment, talk with your provider about why it is being used.

How do I prepare for ECP?

Before each ECP session, you should:

  • Eat low-fat foods a few days before. Blood that has a lot of fat can make it harder for the ECP machine to work. Examples of low-fat foods are whole grains, lean meats like skinless chicken and turkey, fish, low-fat dairy, vegetables, and fruit. For diabetics, it is also helpful to eat a diet low in refined carbohydrates, which means less sugary foods such as white bread, cakes, and other baked goods.
  • Drink plenty of fluid starting at least 2 days before the day of ECP. On the day of treatment, avoid eating breakfast. You should drink 8 ounces of water.
  • If you take medications for high blood pressure or a water pill (diuretic), ask your provider if you should take these on the day of ECP.
  • Bring sunglasses to each session to protect your eyes from the light.
  • Have blood drawn to make sure your blood levels are safe for treatment.

Each session lasts 2-4 hours and you may need many of them. It can help to bring a loved one to your appointments or an activity like a book or electronic device to help distract you.

What can I expect during ECP?

On the day of treatment, you will be given a low dose of a blood thinner to make your blood flow more easily through the ECP machine. An IV will be placed into a vein or a central line will be used.

During ECP:

  • Your blood is collected and run through a machine that separates white blood cells from the rest of the blood.
  • A medication (8-methoxypsoralen or psoralen) is then added to your white blood cells. This medication is a “photosensitizing agent,” meaning it makes your white blood cells more sensitive to light.
  • After the medication is mixed in, the machine shines ultraviolet (UV) light onto the white blood cells. The UV light makes the medication work.
  • Your blood is then given back to you.

Most people don’t have any side effects during treatment. There is a chance you may have:

  • Dizziness.
  • Tingling.
  • Cramping.
  • A cold feeling.

Let your care team know if you feel any changes during treatment.

What should I do after treatment?

  • Remember you can bruise and bleed more easily for 4-6 hours because of the blood thinner you received.
  • Stay out of the sun for at least 12 hours after each treatment. The medication used for ECP will make your eyes and skin more sensitive to the sun. If you must go out, use SPF 30 sunscreen and wear protective clothing, including sunglasses, long sleeves, and a hat.
  • Wear sunglasses for the rest of the day after your treatment.

When should I call my provider?

After ECP, call your provider if:

  • You have a fever or chills. Your provider will tell you at what temperature you should call.
  • If your symptoms seem to be getting worse.
  • If you have any questions about your treatment.

If ECP is part of your treatment plan, talk with your provider about why it is being used, what the goal of it is, what your schedule might look like, and what to expect.

References

Cho, A., Jantschitsch, C., & Knobler, R. (2018). Extracorporeal Photopheresis-An Overview. Frontiers in medicine, 5, 236. https://doi.org/10.3389/fmed.2018.00236.

Cutaneous Lymphoma Foundation. A Primer on Extracorporeal Photopheresis. Retrieved from https://www.clfoundation.org/primer-extra-corporeal-photopheresis.

Klassen J. (2010). The role of photopheresis in the treatment of graft-versus-host disease. Current oncology (Toronto, Ont.), 17(2), 55–58. https://doi.org/10.3747/co.v17i2.565.

National Marrow Donor Program (Be the Match). (2018). Fast facts: Extracorporeal Photopheresis. Retrieved from https://bethematch.org/uploadedfiles/bethematchcontent/patients_and_families/life_after_transplant/physical_health_and_recovery/graft-versus-host_disease_(gvhd)/gvhd_treatment/np20893%20fast%20facts%20ecp.pdf.

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