Severe infections in plasmapheresis-treated systemic lupus erythematosus

Aringer, Martin; Smolen, Josef S.; Graninger, Winfried

doi:10.1002/1529-0131(199803)41:3<414::aid-art6>3.0.co;2-n

Cited by 71 publications

(20 citation statements)

References 22 publications

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“…As stated by Wallace, PP is a remarkably safe and suitable treatment option in seriously ill patients including children and pregnant women (22,23). This is in contrast to Aringer, who in a small, non‐randomized study of nine patients found more bacterial and viral infections in patients treated with IV‐CYC/PP than in patients treated with IV‐CYC alone (24). As all efficacy and side‐effect data with PP is non‐randomized, clinical judgment must be used.…”

Section: Resultscontrasting

confidence: 87%

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

Neuwelt

2003

Ther Apher Dial

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Twenty-six patients, who received plasmapheresis (PP) either alone or synchronized with cyclophosphamide (IV-CYC/PP), are retrospectively reviewed from Medline searches and personal experience from 1976 to 2002. Patients with central nervous system neuropsychiatric systemic lupus erythematosus (CNS-NPSLE) were evaluated according to the American College of Rheumatology (ACR) case definitions of 1999. Eleven of the patients were under the age of 21 years (range 7-21 years), highlighting the need for an aggressive treatment option for young patients who are refractory to other treatments. After treatment with PP or IV-CYC/PP, 74% of patients improved, 13% stabilized, and 13% progressed. Major side-effects occurred from central line placement rather than immunomodulation from PP itself Step-down therapies are needed to supplement IV-CYC/PP once improvement has reached a plateau. Newer combinations of PP and intravenous immunoglobulin (IVIg), human stem cell transplant (HSCT) and rituximab (RTX) should be considered in the future. In the absence of randomized controlled trials (RCT), experienced clinicians must weigh risk, benefit, and cost profiles in considering the treatment of severe CNS-NPSLE with PP.

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Section: Resultscontrasting

confidence: 87%

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

Neuwelt

2003

Ther Apher Dial

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“…Five-year survival has increased from 40% in the 1950s to greater than 90% in the 21st century (Urowitz, Gladman, Tom, Ibanez, & Farewell, 2008). Life expectancy rates for SLE patients are generally reduced because of long-term medication side effect and disease course; consequently, 10% of patients will die within 5 years of diagnosis (Aringer, Smolen, & Graninger, 1998;Smolen, 2002;Urowitz & Gladman, 2000). The course of SLE is varied, and ranges from a nonprogressive illness to rapidly advancing organ failure.…”

Section: Prognosismentioning

confidence: 99%

Systemic lupus erythematosus: A genetic review for advanced practice nurses

Cook

Currie

2011

Journal of the American Academy of Nurse Practitioners

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“…However, aggressive lymphocyte depletion may result in late fungal and viral infections and lymphoproliferative disorders. It is well known that patients with active lupus seem to be at increased risk of infection from immune suppression and disease‐associated T cell abnormalities (13). As has been reported by other investigators (2, 5), our patient also experienced fever and septicemia during ASCT and had an episode of herpes zoster after transplantation.…”

Section: Discussionmentioning

confidence: 99%

Autologous blood stem cell transplantation in refractory systemic lupus erythematosus with severe pulmonary impairment: A case report

Brunner

Greinix

Redlich

et al. 2002

Arthritis & Rheumatism

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For patients with severe forms of autoimmunity, including systemic lupus erythematosus (SLE), purging autoreactive T cells from the immune repertoire by transplanting autologous hematopoietic stem cells (ASCT) is a therapeutic option. We describe an 18-yearold woman with SLE who had been treated with corticosteroids, azathioprine, cyclophosphamide (CYC), and immunopheresis for 4 years, during which time mechanical ventilation for lupus pneumonitis had been repeatedly required. After the patient was conditioned by administration of CYC and antithymocyte globulin, a total of 8.87 ؋ 10 6 purified CD34؉ cells per kg of body weight was infused. Hematopoietic regeneration was observed within 9 days. Twenty-one months after ASCT, the patient continues to be in complete clinical remission, with no signs of SLE-related disease activity and without any immunosuppressive medications. Her pulmonary function has returned to normal. Although a longer followup is required for assessment of the durability of response, the patient's course indicates that ASCT may be a way to reinduce tolerance in patients with SLE.

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Severe infections in plasmapheresis-treated systemic lupus erythematosus

Cited by 71 publications

References 22 publications

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

The Role of Plasmapheresis in the Treatment of Severe Central Nervous System Neuropsychiatric Systemic Lupus Erythematosus

Systemic lupus erythematosus: A genetic review for advanced practice nurses

Autologous blood stem cell transplantation in refractory systemic lupus erythematosus with severe pulmonary impairment: A case report

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