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Treatment of Multiple Sclerosis with Plasma Exchange

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Treatment of Multiple Sclerosis

Part of the book series: Clinical Medicine and the Nervous System ((CLIN.MED.NERV.))

Abstract

The initial studies of plasma exchange (formerly plasmapheresis) as a possible therapy for multiple sclerosis (MS) were published 10 years ago (Dau et al. 1980; Weiner and Dawson 1980). This technique had been shown to be a lifesaving procedure in patients with Goodpasture’s syndrome (Lockwood et al. 1975; Rossen et al. 1976; Walker et al. 1977; Kincaid-Smith and d’Apice 1978; Rosenblatt et al. 1979). Plasma exchange was technically feasible and generally well-tolerated. Although cumbersome and expensive, it could be administered over several weeks, generally in combination with a low dose of an immunosuppressive drug, and was being considered a candidate therapy for a large number of putative autoimmune diseases. As MS was felt to be immunologically mediated, it seemed highly reasonable to commit the resources needed to determine if this treatment approach could be tailored to benefit patients with MS (van den Noort and Waksman 1980). In this chapter I will review the reasons for this early enthusiasm as well as the results of this decade of study.

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References

  • Abdou NI, Lindsley HB, Pollack A et al. (1981) Plasmapheresis in active systemic lupus erythematosus. Effects on clinical serum and cellular abnormalities. Case Report. Clin Immunol Immunopathol 19: 44–54

    Article  PubMed  CAS  Google Scholar 

  • Berkman EM, Caplan S, Kim GS (1978) ABO-incompatible bone marrow transplantation: preparation by plasma exchange and in vivo antibody absorption. Transfusion 18: 504–508

    Article  PubMed  CAS  Google Scholar 

  • Brown JR, Beebe GW, Kurtzke JF et al. (1979) The design of clinical studies to assess therapeutic efficacy ih multiple sclerosis. Neurology 29: 3–23

    PubMed  CAS  Google Scholar 

  • Brubaker DB, Winkelstein A (1981) Plasma exchange in rheumatoid vasculitis. Vox Sang 41: 295–301

    Article  PubMed  CAS  Google Scholar 

  • Carter JL, Hafler DA, Dawson DM, Orav J, Weiner HL (1988) Immunosuppression with high-dose IV cyclophosphamide and ACTH in progressive multiple sclerosis: cumulative 6-year experience with 164 patients. Neurology 38 (Suppl 2): 9–14

    PubMed  CAS  Google Scholar 

  • Cobcroft R (1977) Serial plasmapheresis in a hemophiliac with antibodies to factor V III. Proc HRI Adv Comp Semin, London, England

    Google Scholar 

  • Dau PC, Petajan JH, Johnson KP, Panitch HS, Bornstein MB (1980) Plasmapheresis in multiple sclerosis: preliminary findings. Neurology 30: 1023–1028

    PubMed  CAS  Google Scholar 

  • Dearnaley DR, Martin MFR (1978) Plasmapheresis for paraquat poisoning. Lancet 1: 162

    Article  PubMed  CAS  Google Scholar 

  • Dyck PJ, Daube J, O’Brien P et al. (1986) Plasma exchange in chronic inflammatory demyelinating polyneuropathy. N Engl J Med 314: 461–465

    Article  PubMed  CAS  Google Scholar 

  • Dyck PJ, Pineda A, Low PA et al. (1990) Sham controlled trial of plasma exchange in monoclonal protein associated neuropathy. Peripheral Neuropathy Association Meeting, Oxford, England, pp 17

    Google Scholar 

  • Ellison GW, Myers LW, Mickey MR et al. (1988) Clinical experience with azathioprine: The pros. Neurology 38 (Suppl 2): 20–23

    PubMed  CAS  Google Scholar 

  • Gibberg FB, Billimoria JD, Page NGR (1979) Heredopathia atactica polyneuritiformis ( Refsum’s disease) treated by diet and plasma exchange. Lancet 1: 575–578

    Google Scholar 

  • Giordano GF (1984) Lymphocytapheresis results of treatment in 50 patients with multiple sclerosis. Plasmatherapy 2: 654–658

    Google Scholar 

  • Goodin DS (1990) Letter to the Editor. Neurology 40: 864–865

    Google Scholar 

  • Gordon PA, Carroll DJ, Etches WS et al. (1985) A double-blind controlled pilot study of plasma exchange versus sham apheresis in chronic progressive multiple sclerosis. Can J Neurol Sci 12: 39–44

    PubMed  CAS  Google Scholar 

  • Guarnieri BM, Capparelli R, Fratiglioni L et al. (1985) Plasma exchange in multiple sclerosis. Int J Artif Organs 8: 215–220

    PubMed  CAS  Google Scholar 

  • Hauser SL, Dawson DM, Lehrich JR et al. (1983) Intensive immunosuppression in progressive multiple sclerosis. N Engl J Med 308: 173–180

    Article  PubMed  CAS  Google Scholar 

  • Hauser SL, Fosburg M, Kevy SV, Weiner HL (1984) Lymphocytapheresis in chronic progressive multiple sclerosis: immunologic and clinical effects. Neurology 34: 922–926

    PubMed  CAS  Google Scholar 

  • Herndon RM, Murray TJ (1983) Proceedings of the International Conference on therapeutic trials in multiple sclerosis. Arch Neurol 40: 663–710

    Google Scholar 

  • Höcker P, Stellamor V, Summer K, Mann M (1984) Plasma exchange (PE) and lymphocytapheresis (LCA) in multiple sclerosis ( MS ). Int J Artif Organs 7: 39–42

    Google Scholar 

  • Huestis DW (1986) Complications of therapeutic apheresis. In: Valbones M, Pineda A, Briggs JC (eds) Therapeutic hemapheresis. Wichting Editore, Milan, pp 179–186

    Google Scholar 

  • Jones JV, Cummings CH, Pacon PA (1979) Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus. Q J Med 48: 555–576

    PubMed  CAS  Google Scholar 

  • Kennedy MS, Domen RE (1983) Therapeutic apheresis applications and future directions. Vox Sang 45: 261–277

    Article  PubMed  CAS  Google Scholar 

  • Khatri BO, McQuillen MP, Harrington GL et al. (1985a) Chronic progressive multiple sclerosis: double-blind controlled study of plasmapheresis in patients taking immunosuppressive drugs. Neurology 35: 312–319

    PubMed  CAS  Google Scholar 

  • Khatri BO, McQuillen MP, Harrington GJ et al. (1985b) Plasmapheresis in progressive MS. Neurology 35: 614

    PubMed  CAS  Google Scholar 

  • Khatri BO (1988) Experience with use of plasmapheresis in chronic progressive multiple sclerosis. Neurology 38 (Suppl 2): 50–52

    PubMed  CAS  Google Scholar 

  • Khatri BO, McQuillen MP, Hoffman RG, Harrington GJ, Schmoll D (1991) Plasma exchange in chronic progressive multiple sclerosis: A long-term study. Neurology 41: 409–414

    CAS  Google Scholar 

  • Kincaid-Smith P, d’Apice AJF (1978) Plasmapheresis in rapidly progressive glomerulonephritis. Am J Med 65: 564–566

    Article  Google Scholar 

  • Kiprov DD (1983) Influence of plasmapheresis on cellular immunity. In: Lysaght MJ, Gurland HJ (eds) Plasma separation and plasma fractionation: current status and future directions. Karger, Basel, pp 48–63

    Google Scholar 

  • Klein HG, Balow JE, Dau PC et al. (1986) Clinical applications of therapeutic apheresis. Report of the Clinical Applications Committee, American Society for Apheresis. J Clin Apheresis 3: 1–92

    Article  Google Scholar 

  • Kurtzke JF (1955) A new scale for evaluating disability in multiple sclerosis. Neurology 5:580–583 Kurtzke JF (1986) Neuroepidemiology. Part II: Assessment of therapeutic trials. Ann Neurol 19: 311–319

    Google Scholar 

  • Lian ECY, Harkness DR, Byrnes JJ et al. (1979) Presence of a platelet aggregating factor in the plasma of patients with thrombotic thrombocytopenic purpura ( FI P) and its inhibition by normal plasma. Blood 53: 333–340

    Google Scholar 

  • Lockwood CM, Boulton-Jones, JM, Lowenthal RM (1975) Recovery from Goodpasture’s syndrome after immunosuppressive treatment and plasmapheresis. Br Med J 2: 252–254

    Article  PubMed  CAS  Google Scholar 

  • Luzhnikov EA, Yaraslaysky AA, Molodenov MN (1977) Plasma perfusion through charcoal in methylparathion poisoning. Lancet 1: 38–39

    Article  PubMed  CAS  Google Scholar 

  • Mackin GA, Weiner HL, Orav JA et al. (1990) IV cyclophosphamide/ACTH plus maintenance cyclophosphamide boosters in progressive MS: Interim report of the Northeast Cooperative MS Treatment Group. Neurology 40 (Suppl 1): 260

    Google Scholar 

  • Medaer R, Eeckhout C, Gautama K, Vermijlen C (1984) Lymphocytapheresis therapy in multiple sclerosis, a preliminary study. Acta Neurol Scand 70: 111–115

    Article  PubMed  CAS  Google Scholar 

  • Miller A, Drexler E, Keilson M et al. (1988) Spontaneous stabilization in patients with progressive MS. Neurology 38 (Suppl 1): 194

    Google Scholar 

  • Treatment of Multiple Sclerosis with Plasma Exchange 265

    Google Scholar 

  • Miller RG, Filler-Katz A, Kiprov DD (1985) More on plasmapheresis in chronic progressive MS. Neurology 35: 1261

    PubMed  CAS  Google Scholar 

  • Noseworthy JH, Seland TP, Ebers GC (1984) Therapeutic trials in multiple sclerosis. Can J Neurol Sci 11: 355–362

    PubMed  CAS  Google Scholar 

  • Noseworthy JH (1988) There are no alternatives to double-blind, controlled trials. Neurology 38 (Suppl 2): 76–79

    PubMed  CAS  Google Scholar 

  • Noseworthy JH, Vandervoort MK, Hopkins M, Ebers GC (1989a) A referendum on clinical trial research in multiple sclerosis: the opinion of the participants at the Jekyll Island workshop. Neurology 39: 977–981

    PubMed  CAS  Google Scholar 

  • Noseworthy JH, Shumak KH, Vandervoort MK, The Canadian Cooperative Multiple Sclerosis Study Group (1989b) Long-term use of antecubital veins for plasma exchange. Transfusion 29: 610–613

    CAS  Google Scholar 

  • Noseworthy JH, The Canadian Cooperative Multiple Sclerosis Study Group (1990a) The Canadian Cooperative Study of cyclophosphamide and plasma exchange in progressive multiple sclerosis. Neurology 40 (Suppl 1): 284

    Google Scholar 

  • Noseworthy JH, Vandervoort MK, Ebers GC (1990b) Plasma exchange in MS. Neurology 40: 864

    PubMed  CAS  Google Scholar 

  • Noseworthy JH, Vandervoort MK, Ebers GC (1990c) Plasma exchange in MS. Neurology 40: 1153

    Google Scholar 

  • Noseworthy JH, Vandervoort MK, Penman M et al. (1991) The Lancet 337: 1540–1541

    Article  CAS  Google Scholar 

  • Patten E (1986) Therapeutic plasmapheresis and plasma exchange. CRC Crit Rev Clin Lab Sci 23: 147–175

    Article  CAS  Google Scholar 

  • Rationale for immunomodulating therapies of multiple sclerosis (1988) Neurology 38 (Suppl 2): 1–89

    Google Scholar 

  • Reimann PM, Mason PD (1990) Plasmapheresis: technique and complications. Intensive Care Med 16: 3–10

    Article  PubMed  CAS  Google Scholar 

  • Rock GA, Shumak KH, Buskard NA et al. (1991) Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. N Engl J Med 325: 393–397

    Article  PubMed  CAS  Google Scholar 

  • Rose J, Klein H, Greenstein et al. (1983) Lymphocytapheresis in chronic progressive multiple sclerosis: results of a preliminary trial. Ann Neurol 14: 593–594

    Article  PubMed  CAS  Google Scholar 

  • Rosenblatt SG, Knight W, Bannayan GA, Wilson CB, Stein J (1979) Treatment of Goodpasture’s syndrome with plasmapheresis. Am J Med 66: 689–696

    Article  PubMed  CAS  Google Scholar 

  • Rossen RD, Duffy J, McCredie KB et al. (1976) Treatment of Goodpasture’s syndrome with cyclophosphamide, prednisone and plasma exchange transfusions. Clin Exp Immunol 24: 218–222

    PubMed  CAS  Google Scholar 

  • Rothwell RS, Davis P, Gordon P et al. (1980) A controlled study of plasma exchange in the treatment of severe rheumatoid arthritis. Arth Rheum 23: 785–789

    Article  CAS  Google Scholar 

  • Rudge P, Koetsier JC, Mertin J et al. (1989) Randomised double blind controlled trial of cyclosporin in multiple sclerosis. J Neurol Neurosurg 52: 559–565

    Article  CAS  Google Scholar 

  • Russell JA, Toy JL, Powles RL (1977) Plasma exchange in malignant paraproteinemias. Exp Hematol 5: 105–116

    Google Scholar 

  • Salmi A, Ziola B, Reunanen M, Julkunen I, Wager O (1982) Immune complexes in serum and cerebrospinal fluid of multiple sclerosis patients and patients with other neurological diseases. Acta Neurol Scand 66: 1–15

    Article  PubMed  CAS  Google Scholar 

  • Schildermans F, Dequeker J, Van de Puthe I (1979) Plasmapheresis combined with corticosteroids and cyclophosphamide in uncontrolled active SLE. J Rheum 6: 687

    PubMed  CAS  Google Scholar 

  • Schlansky R, DeHoratius RI, Pincus T, Tung KSK (1981) Plasmapheresis in systemic lupus erythematosus: a cautionary note. Arthritis Rheum 24: 49–53

    Article  PubMed  CAS  Google Scholar 

  • Schwab PJ, Fahey JF (1960) Treatment of Waldenstrom’s macroglobulinemia by plasmapheresis. N Engl J Med 263: 574–579

    Article  PubMed  CAS  Google Scholar 

  • Shumak KH, Rock GA (1984) Therapeutic plasma exchange. N Engl J Med 310: 762–771

    Article  PubMed  CAS  Google Scholar 

  • Silvergleid AJ (1983) Applications and limitations of hemapheresis. Annu Rev Med 34: 69–89

    Article  PubMed  CAS  Google Scholar 

  • Slocombe GW, Newland AC, Colvin MP, Colvin BT (1981) The role of intensive plasma exchange in the prevention and management of haemorrhage in patients with inhibitors to Factor VIII. Br J Haematol 47: 577–585

    Article  PubMed  CAS  Google Scholar 

  • Smith CD, Latortue R, McFarland JG, Menitove JE (1986) Plasminogen deficiency and thrombosis after plasmapheresis therapy for multiple sclerosis. Neurology 36: 1410–1411

    PubMed  CAS  Google Scholar 

  • Spiva DA, Lewis C, Langley JW (1981) New treatment for the porphyrias: porphyria (AIP) and variegate porphyria ( VP ). Blood 58: 186a

    Google Scholar 

  • The Canadian Cooperative Multiple Sclerosis Study Group (1991) The Canadian Cooperative trial of cyclophosphamide and plasma exchange in progressive multiple sclerosis. Lancet 337: 441–446

    Google Scholar 

  • The Guillain-Barré Syndrome Study Group (1985) Plasmapheresis and acute Guillain-Barré syndrome. Neurology 35: 1095–1104

    Google Scholar 

  • Thompson GR (1981) Plasma exchange for hypercholesterolaemia. Lancet 1: 1246–1248

    Article  PubMed  CAS  Google Scholar 

  • Tindall RSA, Walker JE, Ehle AL et al. (1982) Plasmapheresis in multiple sclerosis. Prospective trial of pheresis and immunosuppression versus immunosuppression alone. Neurology 32: 739–743

    Google Scholar 

  • Trouillas P, Neuschwander Ph, Tremisi JP (1986) Modification rapide par les échanges plasmatiques de la sémiologie de formes progressives de la sclérose en plaques. Rev Neurol (Paris) 142: 689–695

    CAS  Google Scholar 

  • Valbonesi M, Garelli S, Mosconi L, Zerbi D, Forlani G (1981) Plasma exchange in the management of patients with multiple sclerosis: preliminary observations. Vox Sang 41: 68–73

    Article  PubMed  CAS  Google Scholar 

  • van den Noort S, Waksman BH (1980) Plasma exchange: aid to therapy of multiple sclerosis? Neurology 30: 1111–1112

    PubMed  Google Scholar 

  • Walker RG, d’Apice Ai, Becker GJ et al. (1977) Plasmapheresis in Goodpasture’s syndrome with renal failure. Med J Aust 875–879

    Google Scholar 

  • Wallace DJ, Goldfinger D, Gatti, et al. (1979) Plasmapheresis and lymphoplasmapheresis in the management of rheumatoid arthritis. Arthritis Rheum 22: 703–710

    Article  PubMed  CAS  Google Scholar 

  • Weiner HL, Dawson DM (1980) Plasmapheresis in multiple sclerosis: Preliminary study. Neurology 30: 1029–1033

    Google Scholar 

  • Weiner HL (1985) An assessment of plasma exchange in progressive multiple sclerosis. Neurology 35: 320–322

    PubMed  CAS  Google Scholar 

  • Weiner HL, Dau PC, Khatri BO et al. (1989) Double-blind study of true vs. sham plasma exchange in patients treated with immunosuppression for acute attacks of multiple sclerosis. Neurology 39: 1143–1149

    PubMed  CAS  Google Scholar 

  • Weiner HL, Khatri BO, Dau PC, (1990) Reply from the authors. Neurology 40: 865

    Google Scholar 

  • Weinshenker BG, Bass B, Rice GPA et al. (1989) The natural history of multiple sclerosis: A geographically based study. I. Clinical course and disability. Brain 112: 133–146

    Google Scholar 

  • Weinshenker BG, Rice GPA, Noseworthy JH et al. (1991) The natural history of multiple sclerosis. A geographically based study. IV. Applications to planning and interpretation of clinical therapeutic trials. Brain 114: 1057–1067

    Google Scholar 

  • Wirguin I, Shinar E, Abramsky 0 (1989) Relapse of multiple sclerosis following acute allergic reactions to plasma during plasmapheresis. J Neurol 236: 62–63

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. John H. Noseworthy
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Editors and Affiliations

  1. Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195-5244, Cleveland, OH, USA

    Richard A. Rudick MD  & Donald E. Goodkin MD  & 

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© 1992 Springer-Verlag London Limited

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Noseworthy, J.H. (1992). Treatment of Multiple Sclerosis with Plasma Exchange. In: Rudick, R.A., Goodkin, D.E. (eds) Treatment of Multiple Sclerosis. Clinical Medicine and the Nervous System. Springer, London. https://doi.org/10.1007/978-1-4471-3184-7_12

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  • DOI: https://doi.org/10.1007/978-1-4471-3184-7_12

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-3186-1

  • Online ISBN: 978-1-4471-3184-7

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