A prospective clinical study evaluated the effects of combined chemotherapy, steroids, and plasmapheresis on 5 patients with mixed cryoglobulinemia with renal or neurologic and vasculitic manifestations. Treatment included prednisone (1 mg/kg/day), chlorambucil (white blood cell count at >3,0W/mm'), and plasmapheresis (1 to 3 litedweek). There was healing of cutaneous ulcers (3/3), improvement in renal function (4/4), and diminution of purpura (2/2), but little improvement in peripheral neuropathy. Complications included leukopenia, perineal ulcers, and osteomyelitis. this syndrome has been carried out. Patients with MCG can be divided into two groups: 1) those with mild clinical manifestations involving mainly the skin and joints, and 2 ) those with renal, neurologic, vasculitic, and hepatic disturbances. Patients with mild disease do not require more than symptomatic treatment with aspirin or other antiinflammatory agents, while those in the second group often require more aggressive treatment to overcome the disabling manifestations of the disease.Over 50 patients with MCG have been seen at the New York University Medical Center since 1960, and the clinical manifestations and long-term followup of 40 of these patients were reviewed recently (1). Among the many types of medications used during this time were nonsteroidal antiinflammatory drugs, antihistamines, cyproheptadine, dextran (for the vasculitic ulcers), corticosteroids, penicillamine, plasmapheresis and immunosuppressive therapy. It was the general impression, based on uncontrolled observations, that severely ill patients did relatively better on steroids and/ or immunosuppressive therapy, but that remissions, if achieved, were short and that side effects of the drugs often necessitated their discontinuation. Other groups have also reported on the use of immunosuppressives and/or steroids (2-4) for the treatment of cryoglobulinemia.There is current interest in plasmapheresis as a promising treatment for immune complex diseases, perhaps by removing complexes and improving reticuloendothelial system function (5). This led us to study 5 patients who had progressively disabling renal impairment, severe neuropathy, or deep cutaneous ulcers during the preceding year. We have treated 4 of these pa-
