Photopheresis

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

What is Photopheresis?

Extracorporeal photopheresis (ECP), also called extracorporeal photoimmune therapy and photochemotherapy, is a treatment used for:

  • Some types of cutaneous T-cell lymphoma (CTCL).
  • Chronic graft versus host disease (GVHD).
  • Refractory heart transplant rejection. 

During ECP: 

  • Your blood is collected and run through a machine that separates the white blood cells from the rest of the blood.  
  • A medication (8-methoxypsoralen or psoralen) is then added to the 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. The medication causes damage to the DNA of the cells. It also makes the disease-producing T-cells more likely to die. 
  • Your blood is then given back to you.  

ECP causes your body’s own immune system to fight the disease-producing T-cells or to help your body accept a transplant.

Who can have Extracorporeal Photopheresis (ECP)?

Your provider may recommend ECP if:

  • You have a certain kind of blood cancer, called cutaneous T-Cell lymphoma (CTCL).
    • To treat CTCL, ECP helps your immune system kill off cancer cells. 
    • You have graft-versus-host disease (GVH or GVHD) after a stem cell or bone marrow transplant.
      • ECP appears to increase the numbers of regulatory T-cells in your body, leading to reduced inflammation. ECP also appears to help eliminate the GVH-causing T-cells. 
      • Your body is rejecting an organ transplant.
        • To treat organ rejection, ECP is done to stop a type of white blood cell, called a T-lymphocyte, 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.

What can I expect during ECP?

ECP is usually painless, aside from the need to have an intravenous (IV) during the duration of the treatment. Each session is often 2-4 hours. You will most likely need several sessions to make sure the treatment is effective. Your care team will discuss your treatment schedule with you. You will need to have your blood tested before each ECP treatment. If your platelet or red blood cell levels are too low, your treatment may be delayed until they rise, or you’ve had a transfusion.

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, reduced-fat dairy, vegetables, and fruit. For diabetics, it is also helpful to eat a diet low in refined carbohydrates, which means less sugar-containing 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 but 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.

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. Your blood will be collected through a needle in your vein. If your veins cannot handle this, you may be told you need a central venous catheter. The blood is then passed through the machine. You will be lying down or reclining in a chair. Since it might take a few hours, be sure to bring a book or tablet with you to pass the time.  

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. 

Once your blood is done in the machine, it will be given back to you through the same IV (into a vein) or through your central venous catheter.  

After treatment, you should:

  • Be aware of easier bruising or bleeding for 4-6 hours from the blood thinner you received.
  • Avoid being in 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 have to 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 medicine5, 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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