Rotherham NH Foundation Trust Rotherham Photopheresis

Treatment Schedule


When a Consultant considers that Photopheresis Treatment would be of benefit to their patient the first step is for them to make a referral to a specialist centre in this case Rotherham NHS Foundation Trust.

On receipt of this referral an appointment will be made at Rotherham for the patient to be seen by the Consultant in charge of Photopheresis. At this appointment various blood tests will be carried out, the patient will be assessed to ensure their suitability for treatment and they will also be taken by one of the Photopheresis nurses to look around the unit.

The results of the tests done at this appointment and confirmation of funding from your local Primary Care Trust are needed before any treatment can be offered.



Photopheresis treatment is given on two consecutive days; either monthly or fortnightly depending on the condition being treated These two days make up one treatment with the second day being a repeat of the first.

Response to Photopheresis is monitored by continual assessment throughout treatment. Baseline assessments and steroid dosage are recorded at first treatment visit and subsequently at every following visit in order that an evaluation of treatment response can be made by the Consultant at three months and three monthly thereafter.

In patients with graft versus host disease the following assessments will be performed:

First Visit:
  • Medical history and clinical examination
  • Drug history
  • Skin assessment: skin score, pruritus (itch)score
  • Eye assessment: Schirmer's Test (test of tear production)
  • Mouth assessment (how sore)
  • Gastrointestinal assessment
  • Joint assessment: If required
  • Blood Tests
  • Respiratory assessment (breathing tests)
  • Medical Photography
  • Karnovsky's scale (self assessment measure of patient's activity)
  • Quality of life assessment (self assessment measure of patient's quality of life)
At each visit for extracorporeal photopheresis treatment:
  • Medical history since last visit.
  • Drug history since last visit.
  • Pruritus (itch) score
  • Eye assessment
  • Mouth assessment
  • Gastrointestinal assessment
  • Joint assessment: If required
  • Blood Tests
  • Karnovsky's scale
At each three monthly visit:
  • Medical history and clinical examination
  • Drug history since last visit.
  • Skin assessment: skin score, pruritus (itch) score
  • Eye assessment: Schirmer's Test (test of tear production)
  • Mouth assessment (how sore)
  • Gastrointestinal assessment
  • Joint assessment: If required
  • Blood Tests
  • Respiratory assessment (breathing tests)
  • Medical Photography
  • Karnovsky's scale (self assessment measure of patient's activity)
  • Quality of life assessment (self assessment measure of patient's quality of life)
What do we mean by "response"?
  1. Complete response - resolution of active GVHD manifestations without systemic immunosuppression
  2. Partial response - > 50% improvement of organ involvement scores (skin, liver or oral mucosa) from baseline investigation and / or > 50% reduction in immunosuppression
  3. Minimal response - < 50% improvement of organ involvement scores (skin, liver or oral mucosa) from baseline investigation and / or 25-50% reduction in immunosuppression
  4. Stable disease - no improvement of organ involvement scores (skin, liver or oral mucosa) from baseline investigation and no reduction in immunosuppression
  5. Progressive disease - worsening of organ involvement scores (skin, liver or oral mucosa) from baseline investigation or new disease in previously unaffected organ or increase in immunosuppression
  6. Maximal response - partial response stable for 3 months with reduced or stable immunosuppression
Treatment Schedule Review

At 3 Months:
  • Complete or partial response: reduce to one cycle every 4 weeks
  • Minimal change or no change despite reduction of corticosteroid by 50%: continue one cycle every 2 weeks
  • If neither of above: stop therapy
At 6 Months:
  • Complete response: taper / stop ECP
  • Partial response: continue one cycle per month until maximal response or stopped corticosteroid then taper / stop
  • If > 50% reduction of corticosteroid dose but less than partial response: consider reduction to one cycle per month and reduce immunosuppressant as tolerated
  • If no further response from 3 months or progressive disease: taper / stop ECP
At 9 months and further 3-monthly assessments:
  • Complete response: taper / stop ECP
  • Partial response: continue one cycle per month until maximal response or stopped corticosteroid then taper / stop
  • If > 50% reduction of corticosteroid dose but less than partial response: reduce to one cycle per month and reduce immunosuppressant as tolerated
  • If no further response from previous 3 months or progressive disease: taper / stop ECP