A Case Report of Double Filtration Plasmapheresis in an Acute Episode of Multiple Sclerosis

Abstract

Plasma exchange has been proposed as support therapy in both acute and chronic forms of multiple sclerosis (MS). For the first time, we aimed to assess whether double filtration plasmapheresis (DFPP) could be clinically efficacious. We describe the case of a patient affected by MS who developed a severe crisis refractory to conventional steroids, and immunosuppressive and immunomodulating therapy. The patient underwent 12 sessions of DFPP. In each session 3000 mL of plasma was treated. Before and immediately after each session the routine laboratory parameters were assessed. Before the apheresis cycle and one month after the end of treatment, encephalic magnetic resonance imaging (MRI) was performed. A neurological examination and assessment of the extended disability status scale (EDSS) were made once each week from the beginning of treatment until one month after the end of the cycle. No therapy was administered during the course of the apheresis cycle, with the exception of a scaled dose of steroids, that was completely withdrawn half-way through the cycle. The immunoglobulin (Ig) G, IgA and IgM values declined from 465 +/- 104 mg/dL, 69 +/- 18 mg/dL, 34 +/- 16 mg/dL, respectively, pre-apheresis to 331 +/- 76 mg/dL, 42 +/- 5 mg/dL, 15 +/- 6 mg/dL, respectively, post-apheresis; C3 and C4 decreased from 105 +/- 27 mg/dL and 21 +/- 5 mg/dL to 75 +/- 9 mg/dL and 15 +/- 4 mg/dL, respectively; fibrinogen went from 228 +/- 72 mg/dL to 128 +/- 28 mg/dL. The EDSS dropped from a value of 6 before the cycle to 5.5 one month after the end of the treatment. As compared with the pretreatment conditions, post-apheresis MRI showed stabilization of the lesions already present, the reduction of one lesion and a complete absence of enhancement of all lesions. DFPP, adopted for the first time in MS, seems to foster a short-term improvement in both the clinical and magnetic resonance images during an acute MS episode.

More Selective Removal of Myeloperoxidase‐Anti‐Neutrophil Cytoplasmic Antibody From the Circulation of Patients With Vasculitides Using a Novel Double‐Filtration Plasmapheresis Therapy

“…While Ramunni et al. reported that DFPP reduced serum IgG by only 28.8% (19). Compared with these results, our modified DFPP procedure obtained a higher reduction ratio of IgG and MPO‐ANCA titer, and did not affect serum albumin level following an albumin supplement of 30–40 g.…”

Double‐Filtration Plasmapheresis for the Treatment of Patients With Recalcitrant Atopic Dermatitis

“…DFPP is a simpler and more economical procedure compared to plasma exchange or immunoadsorption. The clinical efficacy of DFPP has been reported in patients with various autoimmune diseases, including autoimmune blistering skin diseases (Guillain–Barré syndrome, myasthenia gravis, multiple sclerosis, systemic lupus erythematosus, and bullous pemphigoid, and pemphigus) . We hypothesized that DFPP could provide clinical improvements in patients with recalcitrant AD whose disease was not effectively controlled by current standard medical therapies.…”

Akut Dissemine Ensefalomiyelitli Vakanın Çift Filtrasyon Plazmaferez ile Tedavisi

“…Anti-MBP ve anti-MOG immünoglobülin G ve IgM sınıfı antikorlarlardır (11). ÇFP sonrası, ÇFP öncesine göre IgG, IgA, IgM, C3 ve C4'ün plazma seviyelerinde anlamlı düzeyde azalma gösterilmiştir (12). ÇFP uygulamasından daha gelişmiş bir teknik olan immünadsorpsiyon (IA), kandan uzaklaştırılmak istenen maddeye karşı bağlanma kapasitesi olan özel adsorban kolonların kullanıldığı bir plazmaferez yöntemidir.…”

“…Böylece dışarıdan verilen replasman solüsyonlarından kaynaklanan enfeksiyon ve allerji gibi muhtemel risklere maruziyet önlenmektedir. Ayrıca replasman solüsyonlarına ihtiyaç kalmadığından ÇFP, DPD tedavisinden daha ucuzdur (6,12). ÇFP ile serumdaki immünoglobülinler otolog ve yarı seçici olarak temizlenebilmektedir.…”

“…Literatürde ADEM'de terapötik plazmaferez tekniklerinden biri olan DPD gösterilmiştir (16). MS'in akut epizodunda ÇFP tedavisi uygulanmıştır (12). Bildiğimiz kadarıyla bu olgumuz literatürde ADEM'de ÇFP tedavisi uygulanan ilk olgudur.…”