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ECP and gvhd skin

Hi all, I'm looking for tips and information on the ecp treatment I've just started (4th week). The gvhd skin is affecting my legs, arms and now eyes and mouth more and more. Anyone any experience of how long, if at all, it takes to work? Should I reduce fat intake before and after? How many days do I need to wear sunglasses afterwards?

Any tips on dry mouth?

EirianRDaveT

Comments

  • Hi Helen,

    I am currently on Ecp for skin as my skin has become very sclerotic due to gvhd, ie it has become very tight in bands above and below the knee making me very inflexible especially walking and now I can only walk like peg leg for a very short time before feeling very fatigued and unstable. I also seem to get scleroderma in a band around torso where I had lumbar punctures and around shoulder where I had a skin biopsy and these seem to continue to seem tight. I am taking Ecp every two weeks for two cosecutivr sessions and I am currently on my seventh and I have not noticed much difference in skin yet but it has not got worse. My liver gvhd has improved though which I believe is down to ecp. I am currently also on 7.5mg prendisolone. There are many persons with gvhd skin issues on a Facebook gvhd page mainly from US and I saw a survey that 23% saw improvements in gvhd by Ecp in 5 months and 50% saw results in over 6 months. As everyone is different with thier bodies, treatment etc the response will also be different in all of us. I am sorry I have not had a positive outcome to feed back to you as I am going through it like you. Hopefully someone may give more encouraging news or a success story. Good luck and keep fighting.

    HelenSpeedwell
  • Hi Helen and Dave,

    It's several years since I had ECP for skin GvHD so my memory is a little hazy on the details but I'll give you what I can recall of my experience.

    I ended up having around 30 cycles of ECP over the course of about two and a half years. At first I think it was weekly or fortnightly intervals and after a few weeks they reduced the frequency gradually. It increased to monthly, six weeks, bi-monthly, and I think the last session was three or four months.

    It took a while to see a noticable effect and when they tried to reduce my immuno-suppression at one point the GvHD flared up so it was put back to the original rate. Throughout most of the treatment I was still on Ciclosporin and a low dose of Prednisolone, both of which were reduced towards the end.

    I can't recall any special advice about fatty diets, though it would probably make sense to not have anything too fatty in case it affects the machine. Maybe check with the team doing the ECP? As the hospital was quite a way from home, I used to plan the sessions to have a late afternoon session, stay in the hospitals patient hotel overnight and have an early morning session the following day. I'm trying to remember whether I had a cooked breakfast or cereal in the hotel!

    I think the advice was to wear sunglasses for at least a couple of days afterwards whilst outside, until the UV reactive drug had worked its way out of the system. I was also advised to wear long sleeves and gloves whilst driving due to my hands and arms being exposed close to the car windscreen. Generally during the treatment I tried to keep covered up whilst outside anyway as the sun could cause the GvHD to flare. It's probably about 7 years later now I have no lasting effects and can sun bathe happily.

    It does feel like a long time to be continuing treatment after your transplant, but it's worth persisting. My medical team used to send me regularly to the medical photographers to have photos taken for comparison and to monitor progress. I remember seeing the comparison between some of the early and lat ones and the difference was quite dramatic.

    GvHD doesn't work for everybody, but from what I've seen it does appear effective for many. I hope it works for both of you, and for others going through the same.

    To both of you, keep going and hopefully in time you will see results.

    All the best,

    Steve.

    HelenSpeedwell
  • Hi DaveT and dieseldrinker,

    Thank you both for your posts, so supportive. I've ve just got back from my 5th week's ecp, one night and 2 consecutive days. After spending 8 months in the same place lying in bed after my transplant with acute gvhd, I'm realising why I find it so very challenging being there. To find your supportive posts on my return home, well, you both really helped me just being there.

    Today I was seen by a dermatologist and she wants to keep track of a new patch on my face. I wear sunglasses, even indoors for the first 24 hours on their request. I have some expensive but well worth it sun cream with 100sun protect factor. My ankles sound similar to your leg bands DaveT, leading to difficulties walking and my face is now going patchy and changing colour. But that all said, the good news is that they are reducing my ECP to every second week. I nearly cried with joy at the news. They are keeping tabs on things when I'm there, with check ups, examinations and all, but they can see in my blood values that it's taking effect. I'll keep you posted!

    Dieseldrinker62Tom_AnthonyNolan
  • Hi Helen, thanks for the update.

    That's good news that they feel confident to reduce the frequency of your sessions. They will probably only be able to reduce it gradually so you may be on fortnightly sessions for as few cycles now before they can step it back a bit further.

    I wasn't back at work when the ECP started so I didn't find it too disruptive. The hospital was about 60 miles away from home though so it worked out well to have a late afternoon session, overnight stay and an early morning session to keep disruption from home to a minimum. I used to take an iPad and watch a film or video or listen to music during the sessions, which were typically a couple of hours each. I often used to just dose off in the chair which helped pass the time.

    My skin GvHD affected mainly the skin around my eyes and neck, and the skin was blotchy, red and dry and I'm not sure whether it affected my hair growth as the hair on my head was really thin. I look back at old photos of when I had the GvHD and I looked so old and wrinkled! I'm pleased to say that once the GvHD had gone my appearance reverted back to more or less normal.

    Keep plugging away, try and be patient and persevere and the ECP will hopefully resolve your problems eventually.

    Steve

    HelenSpeedwellUnknown
  • Thanks very much Steve. They always have problems with me cos thrombozytes level is so high my blood coagulates really quick and stops the machine, even if they do find a functioning vein. The hospital food is a problem too cos of my gvhd mouth, so I take all my own food, medications and creams. That's why I'm more than over the moon that it's every 2 weeks now. I get the feeling the ecp is working, the fatigue is less. .. and my thrombozytes are down a bit.

    I'm pleased to hear there's hope for me to go back to a normal looking person, at the moment .. wrap around sunglasses and FFP2 mask. I look like a bit of a zombie.

    Dieseldrinker62Unknown
  • Hi Dieseldrinker62

    Hi Steve, that's a good tip about the timing, afternoon and early, I'm going to try for that too although they want everyone early and finish early. Tomorrow morning is a late start at 10am. I'm delighted to read you're 7 years on... it gives me hope.

    Best wishes

    Helen

    Dieseldrinker62
  • Hi Steve and Dave

    My ankles are going like the bands round your torso and walking is becoming more painful.

    To be honest, I think the ecp is affecting my mood too and bringing me down a bit. I have a therapist , thank goodness, but he's not super human but he is definitely better than nothing.

    I'm struggling at the moment but reading over your posts again helped me. Thank you, both of you,

    Helen

  • Hi Helen. Sorry to hear the gvhd is getting you down, I find it does the same to me. My mood swing is up and down like a yo-yo and I keep thinking there is no end in sight. I too am currently like you I have theses tight bands around my legs from ankles to mid thighs and also around torso and my shoulder. Some days these seem tighter than others. I think the best analogy is like bands of concrete as the weight makes it difficult to propel ones self and difficult to bend due to weight. I am still on 7.5mg of prednisone and Ecp every second week and now on about 13th session. I feel often this is not getting me anywhere , but have to remember it is my body doing all the fixing not the drugs. The drugs and Ecp are just holding the immune system back from being too reactive while the body does the work for the new immune system to accept the existing cells in your body. Unfortunately we all just have to be patient for this to happen. We often get too impatient and keep wanting more drugs to fix the problem sooner. However with the drugs developed to hold back different parts of the immune system we quite often cause more issues from the side effects and the body repairing itself can take longer due to the damage some of the drugs can do due to the side effects. If your gvhd is staying fairly stable and issues are not increasing try to stay on your current regime. If they are getting worse it would be best to speak to your sct team. We need to stay positive that we will eventually get there one day and your body is doing the best to get there, we just need to keep it well nourished as best we can, well rested and exercise a bit if we can as this also helps with flexibility as well. My thoughts are with you, I am going through this with you and we will get there!!!!!!!

    Dieseldrinker62Meerkat
  • Hi Helen, I also forgot to mention that most persons who have seen the benefits of Ecp for skin gvhd did not seem to start seeing effects until after 6 months Ecp and it was still slow progress after that. I believe for me it helped reduce my liver function alt results. Prednisone helped bring down my gi gvhd where I could hardly swallow especially most tablets. I am currently trying to hold fire on the steroids and Ecp hoping I may start to see some further progress soon. I recently bought myself a revitive medic which works a bit like a tens machine and exercises the muscles in my calves and helps the blood flow and has brought down the oedema in my legs and this little bit of progress has made me feel a little better. However I believe the revitive medic is not good for anyone who has deep vein thrombosis or pulmonary embolisms. Any little progress whatever it is means you are going in the right direction. All the best.

    Dieseldrinker62
  • Thanks Dave, you've said lots of reassuring stuff which only someone who really knows could say. This gives me trust and belief in what I was losing.. patience. I'll keep you posted.

    Sounds like the skin with the ecp might well take ages. I'll see this one through too. Thanks so much.

  • HI Dave and Helen.

    Dave is right that it does take an inordinate amount of time to see some improvement with the ECP. I was on ECP for around two years but it did eventually cure my GvHD, so please persist with it and give it chance to work. It's an expensiive process so I suspect your clinical team wouldn't continue if they didn't think it was being effective. I know it feels like your treatment is dragging on, but keep going as it will hopefully eventually show results.

    All the best,

    Steve

  • Thanks Steve, you've helped me (and my hubby) accept the situation better. Not easy but patience patience... the neuropathy doesn't help but patience will get me through this.

    Best

    Helen

  • Hi Helen,

    how is your tight skin scleroderma? And the Ecp sessions going? I on Monday and Tuesday went for my Ecp sessions. I was on my 11th round ie sessions 21 and 22. I did not feel too bad after my sessions but today the day after absolutely worn out with no energy and I feel really rough. I am not I’ll I just think the Ecp process takes so much out of me. I know the old T cells are not replaced until 24 to 48 hours after the treatment so I guess the energy replacing the T cells could be what tires me. I cannot see much change to my gvhd at the moment from the Ecp except for bringing my liver gvhd down to nearly normal levels and also maybe keeping any more flare ups at bay. I have to admit I have throughout all when been in presence of other company or at appointments always kept masked as any flu, colds etc can bring on flare ups and I wish my body to spend its resources sorting out gvhd rather than fighting new flare ups from colds and flu. I hope you are making better progress than me, however I know it is a long process requiring lots of patience and many ups and downs.

  • Hi Dave

    I'm right with you. I had a really bad day yesterday, today a little better. That makes sense what you said about energy replacing old t cells. I didn't know that. I feel really sad after the ecp for 3 or 4 days, it seems to take ages to get energy back.

    You're right, patience ...and I'd say trust too. Trust that it could get better with the ecp. It's definitely worth the try, my chronic gvhd makes life quality really poor.

    An app that has really helped me is untire. They have a facebook group too and it really kept me going yesterday in a moment of need.

    I'm sending you kind energy, be your own best friend Dave, especially now. They told me that yesterday in the group and it really helped.

    Helen

  • Hi Helen. Thanks for your kind words. I hope others get some help as well from our updates here as well and I hope others will contribute if they wish. Today 2 days after my Ecp I am feeling a bit better and a bit more positive, somebody else with gvhd I met at Ecp this week unfortunately thier gvhd had got worse. Gi gvhd had flared up, eyes were worse and stomach worse so thier steroids also had been increased also meaning they are now not getting any sleep either. Even though I feel I am currently not aware of any progress forward I luckily have not made large steps backwards. It is such a slow progress and i just need to be patient.

    HelenSpeedwell
  • Hi Dave,

    Our recovery is not lineal, it's more like a scribble. I hope our journies end up moving forward in some way, even if it does take ages. Exhausting,

    Best wishes

    Helen

  • Hello all,

    Could it be that the ecp is making my polyneuropathie and gvhd skin worse?

    Stabbing pain and burning sensation in the ankles. Had the ecp yesterday and today. It's horrible.

    DaveT
  • Hi Helen,

    sounds like you have had a hard tiring day or days with your Ecp. I doubt the Ecp is making your nueropathy or skin worse as really all the Ecp does is calm down your immune system so it is not so over reactive. It may be your body is reacting to the treatment in a positive way and things are starting to wake up. However I would mention it to your consultant if you believe things are getting worse as he may need to change your treatment. It is always to update your consult and with all changes as it can aid recovery. Remember progress is slow and along the road you will take many steps which seem backward in your progress. I know as I have a lot of these and I seem to have had a lot also this week and thinking my legs were tightening which they may have been then after a few days they seem to calm down a bit. I hope the pain and burning sensations subside soon. Have plenty of rest, apply plenty of cream to the skin as is possibly also dry and keep yourself hydrated.

    HelenSpeedwell
  • After looking through posts for users having Ecp and stats from patients, it looks like minor benefits to Ecp are seen after a few weeks such as liver acl going down, but bigger changes such as skin tightness seem to happen after six months of continual Ecp treatment. However for some people it can take longer than 6 months. Everybodies issues are different and body make up is different so timescales and degree of success can also be be different.

    HelenSpeedwell
  • Morning Helen and Dave.

    Dave has hit the nail on the head with his last post in that we are all different so our bodies react differently to treatments. This means that ECP treatment will be variable between patients and in some cases it doesn't always work, but certainly the rate it works will be different for each of us.

    Certainly in my case the initial improvements were fairly quick which really helped the worst parts of the skin GvHD, but then the progressions slowed down. All I can say is keep going as long as your medical teams are happy to continue and they are seing some improvements, no matter how slight. Use whatever methods you can to relieve the symptoms in the meantime.

    Helen, I don't know whether the ECP will be causing your Polyneuropathy but it's ceratinly worth discussing with your medical team. As with anything any of us experience during our treatments, if you notice any changes to your body during treatment, make sure your medical team are aware so that they can treat it as necessary or can reassure you if it's normal.

    Keep going!

    Steve

    HelenSpeedwell
  • Hi Steve and Dave,

    Thank you so very much for your help. You can't imagine how valuable it is. Good to know about possible time scale too.

    I'll mention it to the Dr's team. The nurses just said, no it can't be causing the sensation in the feet ,but I'll mention it to the Dr's team next time. The electric shock , burning feeling is much better today than yesterday. I think I need to keep notes on it.

    Best wishes and big thank you to you both

    Helen

  • Hello all,

    I'm in the week between ECP treatments and at last feeling emotionally a bit better which gave me the energy to eat something and get out and go for a walk in the cold. I was out with my granny walker, got briefly chatting to a couple of people too, only a few words, but it lifted me, the walk and nature too.

    Getting ready for Monday and tuesday 's ecp and next weeks recovery. I've worked out I need about 7 days to feel recovered from the ecp. It's good to know for planning.

    Just thought I'd share a less stressful day with you.

    Best,

    Helen

  • I understand about the Ecp treatment I am still recovering today after my treatment earlier this week. I spent most of the day sleeping. However I think it is the journey each day of treatment over an hour and a half in each direction and then day after hour and a half to and from my consultant appointment. Hopefully will all be worth it as is the best treatment for skin gvhd issues.

    good you managed to walk out gives you some independence back which will also start some of the physiological healing. Unfortunately I am not at that stage yet as skin still too tight that I have not enough stability. Keep up the good work.

    HelenSpeedwell
  • Thanks Dave, I hope you can build up a bit of strength, maybe walking round the front room and extending number of circles... or the stairs.

    Thanks for being with me in spirit, feels supportive, I'm with you.

    Helen

  • Hi Helen,

    I do walk upstairs about three or so times a day and four or five times a day into my kitchen from the lounge. It is so hard though as most of the time my legs are so stiff from the gvhd, and doing other exercises is normally not an option as I am so fatigued. In February this year it was totally different I walked about six houses down with sticks and go up 2 stairs at a time. Then with gvhd my skin got tighter and tighter now I have to pull myself up the stairs, and I suppose I am sort of waiting for the tightness to ease up so I can try to make some headway again.

    it does not help me that in January 2021 I had a secondary cancer on spine giving me a spinal compression, and temporary paralysis toon which meant I had radiotherapy and three months or so in bed and unable to move especially my legs and had so much muscle wastage I had to learn to put weight back on my legs and learn to walk again. So After June 2021 I was learning to walk again very slowly and the gvhd then put me back dramatically and I am hoping the Ecp can weaken at some time my tight skin and rigid knees.

    By motivating yourself to walk outside has shown you have made great progress, I have read from others experience with Ecp you need to stretch the affected areas as much as possible, to exercise those areas as much as you can and even deep tissue

    massage if you can and hopefully the Ecp will eventually aid in breakup of the tight skin as well. So keep up the good work.

  • Hi Dave, that sounds rotten with the secondary cancer. Hope it's under control.

    It sounds like you're doing the best you can under the circumstances. I'm amazed how well you were doing... 2 steps at a time...I can only dream of that.


    Thanks for sharing and I think you have plenty to be proud of. It's an up and down with me too. I was managing 7000 steps a day for a while and now it's just not happening anymore.

    Best

    Helen

  • Hi all,

    I was sent home without ecp this week because I tested positive for covid. The gvhd is already getting stronger. Has anyone else had to have a break from the ecp? Should I ask to increase my jakavi just to see me through this week or two?

    Thanks,

    Helen

  • Hi Helen, Luckily have not skipped Ecp as of yet. I have read user comments that some users have had gvhd get a bit stronger when they try to come off Ecp as the immune system is not being suppressed enough. Also if you are registering positive for gvhd you may have actually had a weak covid. I have also read that for some people an immune response to a virus or infection can cause flare ups to gvhd. When I had my initial flu and COVID vaccines this is when my initial gvhd started, so for now for me no more vaccines and whenever I leave the house the mask stays on always. You will need to speak to your team before you increase any meds as this could cause damage, you need to follow thier advice. Otherwise you will need to wait for your covid symptoms to subside and go back to Ecp which is still a good option to keep your gvhd symptoms down.

  • Your gvhd will eventually go down, it is just a long slow road as we already know and patience. I have had a bit of a down week wondering when I may improve a little, but know I just have to accept the way I am for now. It is difficult. But we must strive on.

  • Thanks Dave,

    It sounds very plausibld what you say, I've had plenty of covid jabs and along with the ecp it probably protected me from symptoms.

    I'm finding it mentally challenging ... to be isolated on top of social isolation. I can't even sit in same room as hubby cos he can't afford to get it. The ankles and feet are getting worse, which you can understand too well. The skin very tight and like I've stuck loads of potato crisps on them with glue, and the skin is as thick as a rhino's.

    Thanks Dave for being there. It's helpful in those endlessly lonely boring phases I experience through these endless days..

    I'm here too, don't forget...

    Best

    Helen

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