Therapeutic Apheresis, Immunosuppression and Human Monoclonal Anti-bodies in Hematologic diseases most with im-munologic origin

Abstract

Therapeutic plasma exchange with hollow fiber modules has been used in different severe diseases for more than 45 years. Updated information on molecular biology and immunology of different diseases, the authors discuss in relation to the rationale for apheresis therapy and its place in combination with other modern therapies such as immunosuppressive drugs, cytotoxic agents, and/or human monoclonal antibodies, With the introduction of novel and effective biologic agents, therapeutic apheresis is indicated in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents. In mild forms of immunologic diseases, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of hematologic diseases has improved in recent years, due in part to very aggressive therapy schemes. For the hematologic diseases, especially diseases with an immunologic origin, such as various anemias, erythrocytosis, theombocytopenia, hyperleukocytosis and coagulation inhibitors that can be treated with therapeutic apheresis, the guidelines of the Apheresis Application Committee of the American Society for Apheresis are cited. Therapeutic apheresis has been shown to effectively remove the toxins, autoantibodies, and other substances from blood and lead to rapid clinical improvement. Therapeutic plasma exchange or immunoadsorption aimed at the causative antibodies can be used in diseases caused by antibodies or immune complexes. Adjuvant drug therapies are different for different diseases and are typically individualized in type, dose and duration of use. Therapeutic apheresis can safely be performed in all severe ill patients and is most combined with an immunosuppression therapy. Human monoclonal antibodies are more introduced in hematologic diseases in recent years.