Surgical outcome in thymic tumors with myasthenia gravis after plasmapheresis - a comparative study

Abstract

Plasmapheresis has been used widely in the treatment of myasthenia gravis and also in symptomatic thymectomized patients with short-term clinical improvement. But the utility of preoperative plasmapheresis in the outcome has not been widely studied. The authors analyzed its impact in the surgical outcome of thymic tumors with myasthenia gravis. We studied a total of 19 patients, who were operated on in the period from January 2000 to July 2006 for thymic tumors with myasthenia gravis. Of these 19 patients, preoperative plasmapheresis was performed in 10 patients (group B) and the remaining nine patients (group A) had no preoperative plasmapheresis based on risk factors for requirement of postoperative ventilation. Outcome in the form of requirement of ventilation, symptomatic improvement, hospital stay and requirement of drugs were assessed at the end of one year and compared between the two groups. Six out of nine patients (67%) in group A required ventilatory support in the immediate postoperative period, whereas two out of ten patients (20%) in group B required it. Significant and sustained symptomatic improvement was noted in group B as compared with group A (P<0.01). Preoperative plasmapheresis in the patients of thymic tumors with myasthenia gravis is beneficial and can cause a significant difference in the postoperative outcome.

Outcomes of Therapeutic Plasma Exchange; One Year Single Center Experience

“…In patients with myasthenia gravis, which included 16 patients, the improvement rate was 81.25%. This was in agreement with studies done by Nagayasu et al [14], who stated remission rate at (79%), and Sarkar et al [15] who stated remission rate of 80%. The difference at improvement rate could be attributed to the total number of cases studied.…”

Comparing the Autoantibody Levels and Clinical Efficacy of Double Filtration Plasmapheresis, Immunoadsorption, and Intravenous Immunoglobulin for the Treatment of Late‐onset Myasthenia Gravis

“…Before 2002 the evidence of plasmapheresis (plasma exchange) treatments for MG was limited (13); however, recently the American Society for Apheresis and the American Association of Blood Banks considered MG as a Category I indication for this procedure (14), and it has been widely used in the treatment of MG, especially as an adjunctive method. For example, plasmapheresis used pre‐operatively can provide a better response after surgery, including thymectomy (15). Compared with the IVIg, it is unknown whether plasmapheresis is better than immunoglobulin in the treatment of late‐onset MG, especially in the removal of specific Titin‐ab in late‐onset MG.…”

Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

“…20,42 In addition, PLEX has been used to prepare patients for thymectomy and has been shown to improve postoperative outcomes. 18 Isolated reports have described cases of IVIg as also being able to prevent MC. 23,43 However, there have been no randomized controlled and double-blind trials to examine the effectiveness of preoperative treatment with IVIg in preventing MC in surgical MG patients.…”