Photopheresis is a medical treatment prescribed by your doctor. The process separates out some of your white blood cells (WBCs) from the rest of your blood and exposes them to ultraviolet light after adding a drug. When exposed to ultraviolet A (UVA) light, the drug becomes activated, which then modifies the function of white blood cells, allowing them to treat your disease. Depending on your medical condition, this may help your body control the cells that contribute to your disease.
Currently photopheresis is indicated to alleviate skin problems associated with Cutaneous T-Cell Lymphoma (CTCL) such as mycosis fungoides or Sezary syndrome. ECP is also used to treat conditions including graft-versus-host disease (GVHD), organ transplant rejection including heart lung and kidney, bronchiolitis obiterans, scleroderma and other autoimmune diseases.
The process requires the patient's blood to be temporarily drawn intravenously and then the white-blood cells (WBCs) are separated before the rest of the blood is returned to the patient. The WBCs are then mixed with a liquid medication called psoralen, which makes the T-lymphocytes more sensitive to ultraviolet (UV) light, more specifically the long wavelength form called UVA. Afterwards, the WBCs are exposed to the UVA, which promotes death of the diseased cells. Then the treated WBCs are returned to the patient. The mechanism of photopheresis is still unclear, and there are several theories on possible ways it works. One such theory states that after the treated WBCs are returned to the body, the immune system recognizes the dying abnormal cells and begins to produce healthy lymphocytes to fight against those cells. It is felt that ECP therapy induces immune tolerance through modulation of antigen-presenting cells as well as the induction of regulatory T cells, thus restoring immune balance.
Like all therapies especially those involving medicine, photopheresis can cause some unwanted effects. The advantage of photopheresis is that the side effects are minimal including a temporary low-grade fever, slight nausea, increased redness of skin six to eight hours after the treatment and dizziness. The severity of these side effects is highly variable depending on the individual. Because the WBCs have been treated by the UVADEX®, there may be some sensitivity to light. Since an anti-coagulant or blood thinner is used while the blood is in the device, there is a small risk of bleeding during or after the procedure. This is usually only a concern in patients with pre-existing clotting or bleeding problems.
The treatment itself takes about three to four hours each day. The frequency of how often the patient needs to come in varies depending on their condition. Patients can usually drive home after their treatment, however on the very first day of treatments patients are advised to bring someone who could drive just in case they experience significant side effects. For 24 hours after a treatment, you should wear wrap-around sunglasses that provide UVA light protection. Avoid sunlight for a day and protect any exposed skin with sun block, at least SPF15.
For the 2 days before the treatment:
Reason: Being well hydrated promotes better blood flow during the procedure. Both caffeine and alcohol can dehydrate you.
The evening before the treatment:
Reason: High levels of fat in the blood can interfere with the cell-separation process and could result in the procedure being stopped before completion.
The day of treatment:
Most insurance policies including Medicare cover the cost of these treatments. Insurance precertification is done prior to patients starting this treatment regimen.
Response time can be different for each patient. You may start to see results within a few weeks, or you might not notice any change for six months or longer, it is important not to give up on the treatment or be discouraged if you don’t see results quickly. Your response may vary depending on the state of your immune system, the severity of your disease and how frequently you receive the treatment. Improvement typically happens gradually.