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Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases

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Abstract

Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1–85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n = 22), myasthenia gravis (n = 21), chronic inflammatory demyelinating polyneuropathy (n = 7), polymyositis (n = 3), multifocal motor neuropathy (n = 2), acute disseminated encephalomyelitis (n = 2), neuromyelitis optica (n = 2), multiple sclerosis (n = 2), limbic encephalitis (n = 1) and transverse myelitis (n = 1). TPE was frontline therapy in 57 % of the patients (n = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1–66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

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References

  1. Weinstein R (2000) Therapeutic apheresis in neurological disorders. J Clin Apheresis 15:74–128

    Article  CAS  PubMed  Google Scholar 

  2. Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, Spasoff RA (1991) Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian apheresis study group. N Engl J Med 325:393–397

    Article  CAS  PubMed  Google Scholar 

  3. Szczepiorkowski ZM, Shaz BH, Bandarenko N, Winters JL (2007) The new approach to assignment of ASFA categories—introduction to the fourth special issue: clinical applications of therapeutic apheresis. J Clin Apher 22:96–105

    Article  PubMed  Google Scholar 

  4. Pinching AJ, Peters DK, Newsom-Davis J (1976) Remission of myasthenia gravis following plasma exchange. Lancet 308:1373–1376

    Article  Google Scholar 

  5. Yeh J-H, Chiu H-C (1999) Plasmapheresis in myasthenia gravis. Acta Neurol Scand 99:147–151

    Article  CAS  PubMed  Google Scholar 

  6. Kunze K, Emskötter Th (1988) The value of plasmapheresis in the treatment of acute and chronic Guillain-Barré syndrome. J Neuroimmunol 20:301–303

    Article  CAS  PubMed  Google Scholar 

  7. McKhann GM, GriYn JW, Cornblath SA, Ouaskey SA, Mellits ED (1988) Role of therapeutic plasmapheresis in the acute Guillain-Barré syndrome. J Neuroimmunol 20:297–300

    Article  CAS  PubMed  Google Scholar 

  8. Susuki K, Johkura K, Yuki N, Hasegawa O, Kuroiwa Y (2001) Rapid resolution of nerve conduction blocks after plasmapheresis in Guillain-Barré syndrome associated with anti-GM1b IgG antibody. J Neurol 248:148–150

    Article  CAS  PubMed  Google Scholar 

  9. Hao W, Davis C, Hirsch IB, Eng LJ, Walsh D, Lernmark Å (1999) Plasmapheresis and immunosupression in stiV-man syndrome with type 1 diabetes: a 2-year study. J Neurol 246:731–735

    Article  CAS  PubMed  Google Scholar 

  10. Fogan L (1996) Progressive encephalomyelitis with rigidity responsive to plasmapheresis and immunosupression. Ann Neurol 40:451–453

    Article  CAS  PubMed  Google Scholar 

  11. Gerraty RP, McKelvie PA, Byrne E (1993) Aseptic meningoencephalitis in primary Sjögren’s syndrome. Acta Neurol Scand 88:309–311

    Article  CAS  PubMed  Google Scholar 

  12. Villani F, SpreaWco R, Farina L, Giovagnoli AR, Bernasconi P, Granata T, Avanzini G (2000) Positive response to immunomodulatory therapy in an adult with Rasmussen’s encephalitis. Neurology 56:248–250

    Article  Google Scholar 

  13. Boers PM, Colebatch JG (2001) Hashimoto’s encephalopathy responding to plasmapheresis. J Neurol Neurosurg Psychiatry 70:132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Bibl D, Lampl C, Gabriel C, Jüngling G, Brock H, Köstler G (1999) Treatment of central pontine myelinolysis with therapeutic plasmapheresis. Lancet 353:1155

    Article  CAS  PubMed  Google Scholar 

  15. Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwart J, Weinstein R, Shaz BH (2010) Apheresis applications committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the apheresis applications committee of the American society for apheresis. J Clin Apher 25:83–177

    Article  PubMed  Google Scholar 

  16. Gwathmey K, Balogun RA, Burns T (2014) Neurologic indications for therapeutic plasma exchange: 2013 Update. J Clin Apher 29:211–219

    Article  PubMed  Google Scholar 

  17. Kaynar L, Altuntas F, Aydogdu I, Turgut B, Kocyigit I, Hacioglu SK, Ismailogullari S, Turgut N, Erkurt MA, Sari I, Oztekin M, Solmaz M, Eser B, Ersoy AO, Unal A, Cetin M (2008) Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Transfus Apher Sci 38:109–115

    Article  PubMed  Google Scholar 

  18. Sorgun MH, Erdogan S, Bay M, Ayyildiz E, Yücemen N, Ilhan O, Yücesan C (2013) Therapeutic plasma exchange in the treatment of neuroimmunologic disorders: review of 92 cases. Transfus Apher Sci 49:174–180

    Article  PubMed  Google Scholar 

  19. Nogales-Gaete J, Valenzuela D, Liendo F, Vidal P, Gil G, Sáez D (2004) Plasmapheresis in neurological diseases. Experience in 140 procedures in 47 patients. Rev Mèd Chil 132:295–298

    PubMed  Google Scholar 

  20. Kaya E, Keklik M, Şencan M, Yilmaz M, Keskin A, Kiki I, Erkurt MA, Sivgin S, Korkmaz S, Okan V, Doğu MH, Unal A, Cetin M, Altuntas F, Ilhan O (2013) Therapeutic plasma exchange in patients with neurological diseases: multicenter retrospective analysis. Transfus Apher Sci 48:349–352

    Article  PubMed  Google Scholar 

  21. Lehmann HC, Hartung H-P, Hetzel GR, Stüve O, Kieseier BC (2006) Plasma exchange in neuroimmunological disorders: part 1: Rationale and treatment of inflammatory central nervous system disorders. Arch Neurol 63:930–935

    Article  PubMed  Google Scholar 

  22. Lehmann HC, Hartung H-P, Hetzel GR, Stüve O, Kieseier BC (2006) Plasma exchange in neuroimmunological disorders: part 2. Treatment of neuromuscular disorders. Arch Neurol 63:1066–1071

    PubMed  Google Scholar 

  23. Linker RA, Gold R (2008) Use of intravenous immunoglobulin and plasma exchange in neurological disease. Curr Opin Neurol Luca 21:358–365

    Article  CAS  Google Scholar 

  24. Clifford DB, De Luca A, Simipson DM, Arendt G, Giovannoni G, Nath A (2010) Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases. Lancet Neurol 9:438–446

    Article  CAS  PubMed  Google Scholar 

  25. Kuwabara S (2004) Guillain-Barre´ syndrome: epidemiology, pathophysiology and management. Drugs 6:597–610

    Article  Google Scholar 

  26. Victor M, Ropper AH (2005) Diseases of the peripheral nerves. Principles of neurology. McGraw-Hill p, New York, pp 1110–1177

    Google Scholar 

  27. Shahar E (2006) Current therapeutic options in severe Guillain-Barre syndrome. Clin Neuropharmacol 29:45–51

    Article  CAS  PubMed  Google Scholar 

  28. The Guillain-Barre Syndrome Study Group (1985) Plasmapheresis and acute Guillain-Barre syndrome. Neurology 35:1096–1104

    Article  Google Scholar 

  29. Van der Meche FG, Schmitz PI (1992) Dutch Guillain-Barre study group. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barre syndrome. N Engl J Med 326:1123–1129

    Article  PubMed  Google Scholar 

  30. The French Cooperative Group on Plasma Exchange in Guillain-Barre Syndrome (1997) Appropriate number of plasma exchanges in Guillain-Barre syndrome. Ann Neurol 4:298–306

    Article  Google Scholar 

  31. Randomised Trial of Plasma Exchange, Intravenous Immunoglobulin, and Combined Treatments in Guillain-Barre´ Syndrome (1997) Plasma exchange/sandoglobulin Guillain-Barre´ syndrome trial group. Lancet 49:225–230

  32. Raphael JC, Chevret S, Hughes RAC, Annane D (2002) Plasma exchange for Guillain-Barre syndrome. Cochrane Database Syst Rev 2:CD001798

    Google Scholar 

  33. Burns TM (2008) Guillain-Barre´ Syndrome. Semin Neurol 28:152–167

    Article  PubMed  Google Scholar 

  34. Gajdos P, Chevret S, Toyka K (2009) Plasma exchange for myasthenia gravis and Intravenous immunoglobulin for myasthenia gravis. The Cochrane Library, No. 1, Article ID CD002277

  35. Pittayanon R, Treeprasertsuk S, Phanthumchinda K (2009) Plasmapheresis or intravenous immunoglobulin for myasthenia gravis crisis in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 92:478–482

    PubMed  Google Scholar 

  36. Barth D, Nabavi Nouri M, Ng E, Nwe P, Bril V (2011) Comparison of IVIg and PLEX in patients with myasthenia gravis. Neurology 76:2017–2023

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hahn AF, Bolton CF, Pillay N, Chalk C, Benstead T, Bril V, Shumak K, Vandervoort MK, Feasby TE (1996) Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy. A double-blind, sham-controlled, cross-over study. Brain 119:1055–1066

    Article  PubMed  Google Scholar 

  38. Dyck PJ, Daube J, O’Brien P, Pineda A, Low PA, Windebank AJ, Swanson C (1986) Plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy. N Engl J Med 314:461–465

    Article  CAS  PubMed  Google Scholar 

  39. Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet 362:971–982

    Article  CAS  PubMed  Google Scholar 

  40. Le Guern V, Guillevin L (2007) Therapeutic apheresis for myositises. Transfus Apheresis Sci 36:169–172

    Article  Google Scholar 

  41. Elovaara I, Apostolski S, van Doorn P, Gilhus NE, Hietaharju A, Honkaniemi J, van Schaik IN, Scolding N, Soelberg Sorensen P, Udd B (2008) EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: eFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol 15:893–908

    Article  CAS  PubMed  Google Scholar 

  42. Marie I (2011) Therapy of polymyositis and dermatomyositis. Presse Med 40:257–270

    Article  Google Scholar 

  43. Galassi G, Girolami F, Ariatti A, Monelli M, Sola P (2012) Fulminant multifocal motor neuropathy: a report of two cases. Int J Neurosci 122:395–400

    Article  PubMed  Google Scholar 

  44. Chaudhry V, Corse AM, Cornblath DR, Kuncl RW, Drachman DB, Freimer ML, Miller RG, Griffin JW (1993) Multifocal motor neuropathy: response to human immune globulin. Ann Neurol 33:237–242

    Article  CAS  PubMed  Google Scholar 

  45. Claus D, Specht S, Zieschang M (2000) Plasmapheresis in multifocal motor neuropathy: a case report. Neurol Neurosurg Psychiatry 68:533–535

    Article  CAS  Google Scholar 

  46. Kanter DS, Horensky D, Sperling RA, Kaplan JD, Malachowski ME, Churchill WH (1995) Plasmapheresis in fulminant acute disseminated encephalomyelitis. Neurology 45:824–827

    Article  CAS  PubMed  Google Scholar 

  47. Shah AK, Tselis A, Mason B (2000) Acute disseminated encephalomyelitis in a pregnant woman successfully treated with plasmapheresis. J Neurol Sci 174:147–151

    Article  CAS  PubMed  Google Scholar 

  48. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG (2002) Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology 58:143–146

    Article  CAS  PubMed  Google Scholar 

  49. Watanabe S, Nakashima I, Misu T, Miyazawa I, Shiga Y, Fujihara K, Itoyama Y (2007) Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult Scler 13:128–132

    Article  CAS  PubMed  Google Scholar 

  50. Bonnan M, Valentino R, Olindo S, Mehdaoui H, Smadja D, Cabre P (2009) Plasma exchange in severe spinal attacks associated with neuromyelitis optica spectrum disorder. Mult Scler 15:487–492

    Article  CAS  PubMed  Google Scholar 

  51. Llufriu S, Castillo J, Blanco Y, Ramió-Torrentà L, Río J, Vallès M, Lozano M, Castella MD, Calabia J, Horga A, Graus F, Montalban X, Saiz A (2009) Plasma exchange for acute attacks of CNS demyelination: predictors of improvement at 6 months. Neurology 73:949–953

    Article  CAS  PubMed  Google Scholar 

  52. Wang K-C, Wang S-J, Lee C-L, Chen S-Y, Tsai CP (2011) The rescue effect of plasma exchange for neuromyelitis optica. J Clin Neurosci 18:43–46

    Article  CAS  PubMed  Google Scholar 

  53. Weinshenker BG, O’Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW, Pineda AA, Stevens LN, Rodriguez M (1999) A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol 46:878–886

    Article  CAS  PubMed  Google Scholar 

  54. Keegan M, König F, McClelland R, Brück W, Morales Y, Bitsch A, Panitch H, Lassmann H, Weinshenker B, Rodriguez M, Parisi J, Lucchinetti CF (2005) Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet 366:579–582

    Article  PubMed  Google Scholar 

  55. Mori M, Kuwabara S, Yoshiyama M, Kanesaka T, Ogata T, Hattori T (2002) Successful immune treatment for non-paraneoplastic limbic encephalitis. J Neurol Sci 201:85–88

    Article  PubMed  Google Scholar 

  56. Wong SH, Saunders MD, Larner AJ, Das K, Hart IK (2010) An effective immunotherapy regimen for VGKC antibody-positive limbic encephalitis. J Neurol Neurosurg Psychia 81:1167–1169

    Article  CAS  Google Scholar 

  57. Greenberg BM, Thomas KP, Krishnan C, Kaplin AI, Calabresi PA, Kerr DA (2007) Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide. Neurology 68:1614–1617

    Article  CAS  PubMed  Google Scholar 

  58. Korach JM, Guillevin L, Petitpas D, Berger P, Chillet P (2000) Apheresis registry in France: indications, techniques, and complications. French registry study group. Ther Apher 4:207–210

    Article  CAS  PubMed  Google Scholar 

  59. Basic-Jukic N, Kes P, Glavasa-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z (2005) Complications of therapeutic plasma exchange: experience with 4857 treatments. Ther Apher Dial 9:391–395

    Article  PubMed  Google Scholar 

  60. Henze T, Prange HW, Talartschik J, Rumpf KW (1999) Complications of plasma exchange in patients with neurological diseases. Klin Wohenschr 68:1183–1188

    Article  Google Scholar 

  61. Rock G, Sutton DM, Freedman J, Nair RC (1997) Pentastarch instead of albumin as replacement fluid for therapeutic plasma exchange. The Canadian Apheresis Group. J Clin Apher 12:165–169

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology, Mersin University Faculty of Medicine, Çiftlikköy Kampüsü, Mersin, Turkey

    Anil Tombak, Mehmet Ali Uçar, Aydan Akdeniz & Eyup Naci Tiftik

  2. Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey

    Arda Yilmaz & Hakan Kaleagası

  3. Department of Biostatistics, Duzce University, Düzce, Turkey

    Mehmet Ali Sungur

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  1. Anil Tombak
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Tombak, A., Uçar, M.A., Akdeniz, A. et al. Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases. Indian J Hematol Blood Transfus 33, 97–105 (2017). https://doi.org/10.1007/s12288-016-0661-3

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