Azize Esra GÜRSOY, Ferda İlgen USLU

Therapeutic plasma exchange in neuroimmunologicdisease: 60 patients experience

Aim: We aimed to determine the results, safety, and applicability of therapeutic plasma exchange (TPE) in neurological diseases.Materials and Methods: We performed a retrospective analysis in between 2014-2019. In the evaluation of response to treatment (RT), patients were divided into 4 groups: full recovery (RT1), partial recovery (RT2), stationary or worse (RT3), exitus (RT4). TPE treatment was evaluated effective in patients with RT1 and RT2. Patients' data were compared between group 1 (TPE as first line treatment) and group 2 (TPE as additional therapy).Results: TPE procedure was applied to 199 patients, 1330 times. Sixty neurological patients (mean age 51.5±17.05; 24 female) underwent 356 TPE procedures on average 6.2 sessions. After TPE, functional status was RT1:3, RT2:19, RT3:28, RT:10. TPE was an effective treatment in 36.6% of patients.Disease distribution Guillain Barre syndrome (n:26), myasthenia gravis (n:8), autoimmune encephalitis (n:6), neuromyelitis optica (n:5), transverse myelitis (n:5), vasculitis (n:3), chronic demyelinating inflammatory polyneuropathy (n:2), multiple sclerosis (n:2), Morvan syndrome (n:1), myeloradiculitis (n:1) and polymyositis (n:1). 7 patients (11.6%) were included in group 1 and 53 patients were in group 2. TPE was started after 9.7 days (±6.9) due to insufficient response. Complications were found in 6 patients (10%). The duration of hospitalization was 28.1 (±13.1) in group 1 and 32.9 (±19) days in group 2 (p: 0.01).Conclusion: Our experience has supported that TPE is a safe and effective treatment option for a wide range of antibody-related neurological disorders, especially if it is the first treatment option.

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1. Ranganathan D, John GT. Therapeutic Plasma Exchange in Renal Disorders. Indian J Nephrol 2019,29:151-9.
2. Pusey CD, Levy JB. Plasmapheresis in immunologic renal disease. Blood Purif 2012;33:190-8.
3. Huestis DW, Corrigan JJ, Johnson HV. Leukapheresis of a five-year-old girl with chronic granulocytic leukemia. Transfusion 1975;15:489-90.
4. Hehmke B, Salzsieder E, Matic GB et al. Immunoadsorption of immunoglobulins alters intracytoplasmic type 1 and type 2 T cell cytokine production in patients with refractory autoimmune diseases. Ther Apher 2000;4:296-302.
5. Lehmann HC, Hartung HP, Meyer Zu, et al. Plasma exchange in neuroimmunological disorders. Part 1. Rationale and treatment of inflammatory central nervous system disorders. Arch Neurol 2006;63:930- 5.
6. Lehmann HC, Hartung HP, Meyer Zu, et al. Plasma exchange in neuroimmunological disorders. Part 2. Treatment of neuromuscular disorders. Arch Neurol 2006;63:1066-71.
7. Aydin Z, Gursu M, Karadag S, et al. Role of plasmapheresis performed in hemodialysis units for the treatment of anti-neutrophilic cytoplasmic antibody-associated systemic vasculitides. Ther Apher Dial 2011;15:493-8.
8. Norda R, Berseus O, Stegmayr B. Adverse events and problems in therapeutic hemapheresis. A report from the Swedish registry. Transfus Apher Sci 2001;25:33- 41.
9. Szczepiorkowski ZM, Bandarenko N, Kim HC, et al. 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 2007;22:106-75. 10. Weinstein R. Therapeutic apheresis in neurological disorders. J Clin Apher 2000;15:74-128.
11. McLeod BC. Therapeutic plasma exchange in neurologic disorders. In: McLeod BC, Price TH, Weinstein R, editors. Apheresis: principles and practice. Bethasda, MD: AABB Press; 2003. p. 321-44.
12. Karaca S, Kozanoglu I, Goksel BK, et al. Therapeutic Plasma Exchange in Neurologic Diseases: An Experience with 91 Patients in Seven Years. Noro Psikiyatr Ars 2014;51:63-8.
13. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice- Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apheresis 2019; 34:171-354.
14. Seker YT, Hergunsel GO, Bilgi DO, et al. Therapeutic plasmapheresis: an eleven-year clinical experience. The European Res J 2018;4:343-8.
15. Ranganathan L, Menon R, Ramakrishnan N, et al. Therapeutic Plasma Exchange Practices in Intensive Care Unit. Indian J Crit Care Med 2019;23:336-8.
16. Kumar AS, Latha B, Dhivya K. Therapeutic plasma exchange in neuro-immunological disorder. Int J Res Med Sci 2017;5:1550-3.
17. Weiss P, Klink AJ, Friedman DF, et al. Pediatric Therapeutic plasma exchange indications and patterns of use in US Children’s Hospitals. J Clin Apher 2012; 27:287-94.
18. Silvestro G, Tison T, Vicarioto M, et al. The Italian Registry of Pediatric Therapeutic Apheresis: A report on activity during 2005. J Clin Apher 2009;24:1-5.
19. Dyck PJ, Daube J, O'Brien P, et al. Plasma exchange in chronic inflammatory demyelinating polyradiculoneuropathy. N Eng J Med 1986;314:461- 5.
20. Hahn AF, Bolton CF, Pillay N, et al. Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy: a double-blind, sham-controlled, crossover study. Brain 1996;119:1055-66.
21. Newsom-Davis J, Wilson SG, Vincent A, et al. Long-term effects of repeated plasma exchange in myasthenia gravis. Lancet 1979;1:464-8.
22. Schilling S, Linker RA, König FB, et al. Plasma Exchange therapy for steroid unresponsive multiple sclerosis relapses: Clinical experience with 16 patients. Nevenarzt 2006;77:430-8.
23. Ozkale M, Erol I, Ozkale Y, et al. Overview of therapeutic plasma exchange in pediatric neurology: a singlecenter experience. Acta Neurol Belgica 2018; 118:451- 8.
24. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDAreceptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008,7:1091-8.
25. Kohler W, Ehrlich S, Dohmen C, et al. Tryptophan immunoadsorption for the treatment of autoimmune encephalitis. Eur J Neurol 2015,22:203-6.
26. Miller FW, Leitman SF, Cronin ME et al. Controlled trial of plasma exchange and leukapheresis in polymyositis and dermatomyositis. N Engl J Med 1992;326:1380-4.
27. Le Guern V, Guillevin L. Therapeutic apheresis for myositis. Transfus Apher Soc 2007;36:169-72
28. Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: complications and management. Am J Kidney Dis 1994;23:817-27.
29. Norda R, Stegmayr BG, Swedish Apheresis G. Therapeutic apheresis in Sweden: update of epidemiology and adverse events. Transfus Apher Sci. 2003;29:159-66.
30. Yeo FE, Bohen EM, Yuan CM et al. Therapeutic plasma exchange as a nephrological procedure: a singlecenter experience. J Clin Apher 2005;20:208-16.
31. Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher 2007;22:270-6.
32. Kundrapu S, Datla S, Griffin V, et al. Adverse Events During Apheresis: A Ten-Year Experience at a Tertiary Academic Medical Center. J Clin Apher 2019;34:528- 36.
33. McGrogan A, Madle GC, Seaman HE et al. The epidemiology of Guillain-Barré syndrome worldwide. A systematic literature review. Neuroepidemiology 2009;32:150-63.
34. Van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch GuillainBarré Study Group. N Engl J Med 1992;326:1123-9.
35. Diener HC, Haupt WF, Kloss TM et al Study Group. A preliminary, randomized, multicenter study comparing intravenous immunoglobulin, plasma exchange, and immune adsorption in Guillain-Barré syndrome. Eur Neurol 2001;46:107-9.
36. Nomura K., Hamaguchi K, Hattori T, et al. A randomized controlled trial comparing intravenous immunoglobulin and plasmapheresis in Guillain– Barré syndrome. Neurol Therapeut 2001;18:69-81.
37. Klinov V, Campellone J. Comparison of the length of hospital stay between treatment with plasma exchange versus IVIG in mild Guillain Barre Syndrome (P7.064). neurology, 06,2015; 84 (14 supplement).
38. Saad K, Mohamad IL, Abd El-Hamed MA, et al. A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain-Barré syndrome in Upper Egypt. Ther Adv Neurol Disord 2016;9:3-8.