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Your extracorporeal photopheresis appointment

 

Dermatology

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Clinic location

Chemotherapy Village, level C1
Guy's Cancer Centre
Guy's Hospital
Great Maze Pond
London SE1 9RT

  • If you have not received an appointment

    Normally, your appointment is booked immediately after being reviewed by the consultant. If you haven’t received any appointment, please contact the pathway coordinator Katie King:

    Tel: 020 7188 7188 (ext 53867)
    Mob: 07468 741687
    Email: katie.king@gstt.nhs.uk

  • Changing or cancelling your appointment

    Contact Katie King:

    Tel: 020 7188 7188 (ext 53867)
    Mob: 07468 741687
    Email: katie.king@gstt.nhs.uk

    Or call ECP clinical nurse specialist Sukran Saglam on 07717 427284.

  • What to bring to your appointment

    Please bring a pair of sunglasses on your first day of treatment; they will be checked by our team to ensure they have adequate protection from UV light rays. Please also bring sunscreen and a bottle of water to hydrate before treatment.

    Hydration prior to treatment is important and we encourage patients to drink plenty of water prior to attending on the day of treatment.

    Please bring all current medication to your initial assessment appointment and please let the staff know of any changes in medication when you attend for treatment.

  • What to expect at your appointment

    Extracorporeal photopheresis (ECP) is performed over 2 days (1 cycle) at intervals of 2 -4 weeks. The number of cycles required depends on the condition being treated and the response obtained which will be discussed with you at your assessment appointment and progress reviewed at regular intervals.

    On arrival, you will be seated in a comfortable chair. Blood tests are taken on the first day of each cycle to ensure that the blood count is adequate for treatment and to monitor kidney and liver function. Blood pressure, temperature and heart rate will also be taken prior to starting treatment. Cannulas will be inserted in both arms for simultaneous collection and returning of your blood (unless you have a central venous line which will be used instead). The needles will be connected to the ECP machine via tubing. Once the treatment is initiated it is important to keep your arm still until the cells have been treated.

    During ECP, 1500mls of whole blood is taken. The red blood cells (RBCs) are then separated from the white blood cell containing buffy coat. The remaining plasma and  RBCs  are then returned via another cannula inserted in the opposite arm.

    Methoxalen (Uvadex) is a photosensitising drug which is added to the buffy coat in addition to an anticoagulant (heparin). The buffy coat is then passed through a sterile chamber and irradiated with ultraviolet light which activates the drug. The methoxalen binds to the DNA in the buffy coat cells, leading to cell death (apoptosis). The buffy coat cells are then returned in order to produce the desired response in the body. 

    The treatment usually takes between 2-3 hours. It is usually well tolerated. Sometimes patients can feel weak or dizzy during or immediately after the procedure and is due to a slight drop in blood pressure. This is more common if you have not had an adequate fluid intake before treatment.                       

  • After your appointment

    Sunglasses with effective UV protection should be worn when outside or under bright lighting for 24 hours after the procedure. A sunblock (SPF 50) should be applied to exposed skin.

    Common side effects include bruising and bleeding at the cannula sites. Some patients develop a short-lived low grade fever following treatment. Extreme tiredness following treatment is also reported by some patients.

    If you are unwell a day or a few days before your next scheduled appointment, please contact your allocated key worker, clinical nurse specialist or the medical team looking after you.