Overview
Extracorporeal photopheresis
Extracorporeal photopheresis (ECP) is a procedure to treat:
- sézary syndrome (a type of cutaneous T-cell lymphoma)
-
graft versus host disease (GvHD) (a complication from a bone marrow or stem cell transplant)
During ECP, small amounts of blood are removed from your body. Your white blood cells are separated from the rest of your blood by a process known as centrifugation. The white blood cells are treated with a medicine called psoralen, and exposed to ultraviolet A (UVA) light. The treated cells are then put back into your body, with the rest of your blood. These treated cells help to change your immune response to the condition we are treating.
Our ECP unit is the largest in Europe. We have 6 chairs and provide up to 24 treatments every day.
Benefits of treatment
Each patient is different, but on average changes are seen 4 to 6 months after starting treatment.
If you are being treated for cutaneous T-cell lymphoma, in particular sézary syndrome, you may notice less redness, itchiness, and scaling of your skin.
If you are being treated for graft versus host disease (GvHD), the benefits of ECP will depend on which organs are affected. Your consultant will discuss this with you in more detail.
Risks of treatment
Light sensitivity
Your white blood cells are activated with psoralen and treated with UVA light. This can make your skin and eyes sensitive to UV rays. We recommend that sunglasses are worn when outside, or under bright lights for 1 day after your treatment.
Wrap-around UVA and ultraviolet B (UVB) sunglasses provide the best protection. You may increase your risk of developing cataracts in your eyes at a later date if you are exposed to the sun after treatment.
A sunscreen with a sun protection factor (SPF) of at least of 50 should be applied after treatment, even if it is cloudy.
Pregnancy
There is little evidence that using psoralen while pregnant affects your unborn baby. However, if you are able to become pregnant, we advise that you use reliable contraception during treatment.
If you are already pregnant, you must let your doctor or nurse know before you start treatment.
Anaemia
Patients having ECP can develop anaemia. When the procedure is finished, a small amount of your blood will not be returned to you. The main symptom of anaemia is tiredness. This is caused by a lack of red blood cells, which carry oxygen around your body, and are carried in a protein called haemoglobin. We will monitor this at each session by taking regular blood tests. If your haemoglobin levels have dropped quite a lot, you might need a blood transfusion.
Who cannot have ECP
Some people cannot have this treatment. Tell your doctor immediately if you have:
• a sensitivity, or have had reactions to, psoralen in the past
• any blood clotting (coagulation) conditions
Some people cannot tolerate the changes in blood volume which happen during this treatment, because of a low body weight for example. They also might not be recommended to have treatment.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.
Read more about our consent process.
Our consultants
Bjorn Thomas
Research and clinical trials
Research is vital to improving the care that you receive. You can help improve healthcare by taking part in research studies at our Trust. During your appointment, ask your healthcare professional about research. They'll be happy to tell you about research studies you could be eligible to join.
You can email dermatologytrials@gstt.nhs.uk for more information.
Last updated: July 2024
