Photopheresis

Overview

Photopheresis, also known as extracorporeal photoimmunotherapy (ECP) or photochemotherapy, is a procedure that uses light to modify white blood cells called lymphocytes, which are crucial in your body’s immune response by attacking cancer cells, bacteria, and viruses. By altering lymphocytes, photopheresis can either enhance or suppress the immune response, enabling it to either activate these cells to target harmful cells like cancer or prevent them from attacking the body’s own cells, as seen in conditions like graft-versus-host disease after a bone marrow transplant.

Reasons for undergoing the procedure

Photopheresis is a type of immunotherapy that harnesses your immune system to address specific conditions. It may be used for:

• Cutaneous T-cell lymphoma (CTCL): In the 1980s, photopheresis was created as a CTCL treatment. A rare type of blood cancer that affects the skin is called CTCL. Sézary syndrome and mycosis fungoides are the two forms of CTCL that are being treated with photopheresis.
• Graft Versus Host Disease (GVHD): If other first-line therapies, such as corticosteroids, aren’t working for you, your doctor may prescribe photopheresis. The donor stem cells you get after an allogeneic bone marrow transplant perceive your body as alien and begin attacking it if you have GVHD. The onslaught is slowed or stopped via photopheresis.
• Rejection of an organ transplant: To stop your body from rejecting a major organ transplant (such as a liver, heart, or lung), your doctor may administer photopheresis.

Your doctor may also use photopheresis to treat the following conditions:

• Pemphigus.
• Psoriasis.
• Scleroderma.
• Type 1 diabetes.
• Crohn’s disease.
• Eczema (atopic dermatitis).
• Nephrogenic systemic fibrosis.

Your lymphocytes’ function is altered during photopheresis by the treatment you give them. Once the treated lymphocytes are reintroduced into your body, they will help your body mount an immunological defense against cancerous cells or prevent the advancement of GVHD. They will stop your body from targeting a fresh organ. Additionally helpful in reducing the symptoms of these illnesses is photopheresis.

Risks

Photopheresis is generally considered a safe procedure with minimal side effects. However, some individuals may experience a slight drop in blood pressure during the process, which can be managed with intravenous fluids to stabilize it. Other potential side effects include nausea, skin redness, dizziness, and fever occurring about six to eight hours after the procedure. If you develop a temperature over 37.77°C, it’s important to inform your healthcare provider, who may recommend taking medications like acetaminophen to manage the symptoms.

Before the procedure

The preparations you need to make will be explained by your doctor. They might advise you to:

• To help improve blood flow, drink a lot of fluids (at least eight glasses per day) for two days prior to therapy. During the operation, drawing blood will be simpler as a result.
• Steer clear of alcohol and caffeine to avoid dehydration, which can cause your blood flow to slow.
• Steer clear of high-fat items, such as fried foods and pastries, as these can complicate the process of separating your blood components by the machine used during photopheresis.

During the procedure

Through the process of photopheresis, your lymphocytes are isolated from the remainder of your blood, treated, and then returned to you with the remaining blood.

In the process:

• Using an IV or a small plastic tube known as a catheter, a medical professional will draw blood from a vein in your arm or chest. To stop pain or discomfort, you might be given a sedative or topical anesthetic.
• The machine will add a material called 8-Methoxypsoralen (8-MOP) to your white blood cells.
• The blood will be fed into a machine that separates your lymphocytes from the other components of your blood, such as red blood cells, platelets, and plasma. When exposed to light, the plant-based compound 8-MOP becomes active and harmless.
• Inside the machine, Ultraviolet A (UVA) light will be introduced to the lymphocytes along with the 8-MOP. The 8-MOP will become active in response to light, altering how lymphocytes behave.
• Your body will be reinfused with your blood, which includes the treated lymphocytes.
• The lymphocytes will either be deactivated to prevent them from mounting an immune reaction to healthy stem cells or a new organ, or they will be activated to combat cancer cells.

During the photopheresis operation, you will be lying comfortably in bed while your blood is drawn, processed, and then reinfused. The process of photopheresis is painless.

You can have symptoms during and right after the process that are comparable to blood donation. You may feel cold, lightheaded, nauseous, or dizzy due to changes in blood volume. If you encounter any of these signs, let your doctor know, and they will assist in easing your pain.

After the procedure

The doctor will check your blood pressure, pulse, and overall well-being, and if all your vital signs are normal with no adverse effects, you’ll be able to return home. The photopheresis procedure typically takes three to four hours to complete, and multiple sessions may be necessary to see improvement in your condition. Initially, you might require weekly or biweekly treatments as your symptoms improve. Your doctor will develop a personalized treatment plan tailored to your specific needs.

Outcome

Your sensitivity to the sun is increased with photopheresis. Avoid sunlight, even indirect sunlight, for 24 hours following each treatment to protect yourself. Light coming in via a window, blinds, or curtain is considered indirect sunlight.

When venturing outside, protect your skin with a sunscreen that has at least SPF 30. To shield the sides of your eyes, put on “wraparound” style UVA-blocking sunglasses. Most medicine stores carry UVA sunglasses in a variety of hues, including clear. Following each photopheresis therapy session, you should wear these both indoors and outdoors for a full day.

Response periods differ based on your health and the regimen you follow for treatment. For instance, after undergoing photopheresis, some research has shown that patients with persistent GVHD see improvements in three to four months. However, it could take six to twelve months of treatment for someone with scleroderma before their symptoms become better.

Inquire with your doctor about how soon you should expect outcomes given your condition and frequency of treatments.