Plasmapheresis Procedures Research Articles

Predictive Model of variable laboratory findings calculation and monitoring during plasmapheresis procedures

Predictive Model of variable laboratory findings calculation and monitoring during plasmapheresis procedures

Retrospective evaluation of indications for therapeutic plasmapheresis procedures applied in our center

Aims: Therapeutic plasma exchange (TPE) is a process in which pathological substances (autoantibodies, alloantibodies, immune complexes, lipoproteins, cryoglobulins, etc.) in the patient's plasma are removed from the body along with the patient's plasma and replaced with replacement fluid (allogeneic donor plasma, colloid, crystalloid). It is applied as a complementary treatment method in many diseases that can cause high morbidity and mortality, either in the primary treatment of the disease (main treatment) or as an adjunctive treatment in the main treatment of the disease. Today, TPE is increasingly used in various clinics (toxicology, endocrinology, etc.) for different diseases/causes, especially in hematological, neurological, and nephrological diseases. Methods: Adult patients who underwent therapeutic plasma exchange in our therapeutic apheresis center between May 2017 and May 2019 were included in the study, and the data were obtained by retrospectively reviewing patient records in the therapeutic apheresis center and our hospital's automation system. Results: In the two-year period, a total of 1957 TPE procedures were performed on 441 patients. It was determined that 255 of the patients undergoing TPE procedures (57.8%) had indications related to liver diseases (acute liver failure, acute exacerbation of chronic liver failure, and rejection after liver transplantation), while 186 (42.2%) had indications related to non-liver diseases. Among the 186 patients undergoing TPE for non-liver diseases, it was found that 69 (37.1%) were for hematological, 38 (20.4%) for neurological, 32 (17.2%) for renal, and 47 (25.3%) for other diseases. Conclusion: Due to the large number of liver transplants performed in our Liver Transplant Institute, the majority of TPE indications at our hospital are related to liver diseases. However, the evaluation of TPE indications excluding liver diseases revealed that the indications and frequencies of patients undergoing TPE were consistent with the overall results reported in studies from both our country and abroad.

A donor safety evidence literature review of the short- and long-term effects of plasmapheresis.

Many blood establishments are expanding plasmapheresis collection capacity to achieve increasing plasma for fractionation volume targets, driven by immunoglobulin product demand. Some adverse events occur in both apheresis and whole blood collection, such as venepuncture-related trauma and vasovagal reactions. Others are specifically related to the apheresis procedure, such as citrate reactions, haemolysis, infiltration and air embolism. Whilst plasmapheresis procedures are generally well tolerated, theoretical longer term donor health considerations, such as the effects on donor plasma protein levels, bone mineral density, iron deficiency and malignancy also require consideration. An evidence-based framework that supports a safe and sustainable increase in the collection of plasma is essential. Our review demonstrates a lack of high-quality evidence on risks and outcomes specifically in plasmapheresis. Whilst conservative procedural controls and donor harm minimization policies will mitigate risk, high-quality evidence is needed to facilitate practice change that is safe and sustainable and maximizes the potential of individual donor differences.

#4583 NEUROLOGICAL DISEASES TREATED WITH PLASMAPHERESIS PERFORMED BY NEPHROLOGISTS

Abstract Background and Aims Apheresis is an extracorporeal technique whose objective is to eliminate pathological elements considered to be responsible for a disease or its clinical manifestations. Plasmapheresis is part of the nephrology activity that will precise to be promoted within clinical practice. It is a therapeutic alternative for a large number of diseases, with certain neurological pathologies being the most benefited of its use. The purpose of this study is to describe the experience with plasmapheresis performed by nephrologists on patients with neurological diseases. Method Descriptive-retrospective study of neurological diseases treated with plasmapheresis in our nephologist section between the years 2008-2023. We analyzed demographic data, underlying disease, procedure, complications, and clinical response of the patients. Results A total number of 31 plasmapheresis procedures have been performed, of which 16 procedures have been performed in neurological diseases with a total of 92 sessions. The average age was 47 years, with 69% of the female sex predominance. The most frequently disease treated was Multiple Sclerosis with 31%, followed by Acute demyelinating polyneuropathy in the form of Guillain Barré with 25%, Myasthenia Gravis and Voltage-Gated Potassium Channel Antibody Related antiLGi-1, both with 13%. Treatment prior to the technique was corticosteroids with 75%, immunoglobulins with 56% and immunosuppressants with 13%. All sessions were performed using the transmembrane filtration technique with plasmaFlux® and the Fresenius mulitiFiltrate® equipment. The median number of sessions per patient was 6. The mean exchange volume was 2.9 l/patient/session. The replacement fluid used was albumin on 100% of patients and 4 patients required albumin plus fresh frozen plasma. 75 percent of the patients had a positive response with partial remission or stability of the disease and 88 percent had no recurrences. Patients’ neurological response to the therapy was the expected, and similar to the one reported in the medical literature. Conclusion In our experience, plasmapheresis is a safe and effective therapy in patients with neurological diseases that should be required as a therapeutic option. We, as nephrologists must be aware of this and promote the management of this technique by publishing the joint experience in order to broaden the level of evidence in clinical practice. The importance of coordination in early referral by other different medical specialties may obtain better results.

The Efficacy and Safety of Plasma Exchange in the Treatment of Thrombotic Thrombocytopenic Purpura.

Background Thrombotic thrombocytopenic purpura (TTP) is a clinically rare thrombotic cardiovascular and microvascular disease. The purpose of this study was to observe the clinical efficacy and safety of plasma exchange in the treatment of TTP. Methods A total of 16 TTP patients who underwent plasma exchange from January 2015 to December 2020 were selected. The clinical data of all patients were collected for retrospective analysis. The effective rate of treatment, the changes of blood cell count before and after treatment, and adverse reactions during treatment were analyzed. Results A total of 50 plasma exchanges were performed in 16 TTP patients. After plasma exchange treatment, there were 4 invalid and 12 improved patients. The total effective rate of plasma exchange in patients with TTP was 75.0%. After treatment, platelet count (PLT) and hemoglobin (Hb) levels were significantly increased in TTP patients. Compared with before treatment, lactate dehydrogenase (LDH), indirect bilirubin (IBIL), total bilirubin (TBIL), and broken red blood cells were significantly reduced. In addition, 3 adverse reactions occurred in 50 plasmapheresis procedures, and the incidence of adverse reactions was 6.0%. Conclusion Plasma exchange therapy has a good therapeutic effect on TTP and can significantly improve abnormal blood cell count in patients with high safety.

Single Donor Plasmapheresis for COVID-19: An Experience from a Tertiary Care Hospital Based Blood Centre

Introduction: Corona Virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) became a global health problem since December 2019. No single treatment was found to be effective against COVID-19. Transfusion of COVID Convalescent Plasma (CCP) was found to be a useful and logistically feasible therapeutic strategy in COVID-19. Aim: To study the feasibility of single donor plasmapheresis for COVID-19, to analyse statistical significance of clinico- demographical data and biochemical parameters of convalescent plasmapheresis donors and to further study the adverse reactions and technical problems that occurred during the procedure of single donor plasmapheresis. Materials and Methods: A prospective observational study was carried out over a period of 10 months from June 2020 to March 2021. The study included 235 screened donors and 50 procedures for single donor plasmapheresis (SDPs). Donors were selected as per the standard criteria given by Indian Council of Medical Research (ICMR). All plasmapheresis procedures were performed on an automated blood cell separator. The results were tabulated and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Results: Out of 235 prospective CCP donors, 164 (69.78%) were found eligible. The causes of non eligibility donors were unwillingness to donate, absence of SARS-CoV-2 antibody, Transfusion Transmitted Disease (TTD) positivity, and improper haematological parameters. Actual plasma donations were carried out in 50 (21.27%) eligible donors. Therapeutically needed amount of CCP (400 mL) could be collected from most of the donors. Adverse reactions were seen in 4 (8%) donors. Conclusion: Adequate amount of CCP could be collected by single donor plasmapheresis with satisfactory technical support. The procedure was well accepted by the prescreened donors with minimum adverse reactions.

To Evaluate the Effectiveness of Plasmapheresis as a Method for the Graft Disease Prevention in Patients with Keratoplasty

Purpose: to evaluate the effectiveness of plasmapheresis as a method for preventing and treating the graft rejection reaction in corneal transplantation.Patients and methods. The study involved patients with surgical pathology of the cornea, who underwent a prophylactic course of plasmapheresis procedures and underwent penetrating keratoplasty (Main group); and patients with surgical pathology of the cornea who underwent penetrating keratoplasty, but did not undergo plasmapheresis (Comparison group), whose data were analyzed retrospectively. The control group consisted of conditionally healthy individuals of both genders. Subgroups of patients with high and low risk keratoplasty were also identified within the Main group and the Comparison group.Results. Patients with keratoplasty who received a course of therapeutic plasmapheresis in the perioperative period demonstrated a statistically significant increase in the number of cases of a decrease in the level of C-reactive protein and a statistically significant decrease in the median values of the mean stimulated cytochemical index and the mobilization coefficient. Depending on the risk group for keratoplasty, the patients showed different dynamics of the levels of the studied interleukins after the course of plasmapheresis and keratoplasty. In patients of the Comparison group who did not receive a course of plasmapheresis in the preoperative period, over a period of 1.3 years, 22 cases (24 %) developed graft disease, while patients of both subgroups of the Main group who received a course of therapeutic plasmapheresis in the preoperative period, didn’t demonstrate any cases of graft disease. In patients of the Comparison group (in total for two subgroups), the maximum number of cases of graft disease (n = 24) was observed in the first 500 days after surgery. At the same time, the patients of the Main group who underwent plasmapheresis had the best graft survival rates: during the observation period, there were no cases of graft disease (in both subgroups).Conclusion: the obtained data indicate the ability of plasmapheresis, performed in the perioperative period, to prevent the development of graft disease in patients with keratoplasty.

Long-term outcomes and prognostic factors in generalized myasthenia gravis.

This study aimed to investigate the timing of meeting the criteria for a status of "minimal manifestation (MM) or better" and the factors that influenced whether "MM or better status" or "MM or better status with an oral prednisolone (PSL) dose of 5mg/day or less (5-mg MM)" was met in patients with acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (MG). We performed a retrospective study in 93 patients with AChR antibody-positive generalized MG who were followed for 3years after the start of immunotherapy. We reviewed clinical data, such as MG-related symptoms, the MG activities of daily living profile (MGADL) score, immunotherapy including the dose of PSL, and achievement of the status of MM or better at baseline and 3, 6, 12, 24, and 36months after treatment. An MM or better status was achieved in 60% of the patients 3months and in 90% of the patients 2years after initiating immunotherapy. At 2years, 60% of the patients had achieved the treatment goal, which was an "5-mg MM". More frequent plasmapheresis and higher dose of PSL within 3months after immunotherapy initiation were associated with difficulty in achieving the 5-mg MM status at 2years. Approximately 60% of the MG patients achieved the treatment goal within 2years after treatment. PSL dose and the cumulative number of plasmapheresis procedures at 3months after immunotherapy initiation may help identify treatment-resistant patients with MG.

Donors for SARS-CoV-2 Convalescent Plasma for a Controlled Clinical Trial: Donor Characteristics, Content and Time Course of SARS-CoV-2 Neutralizing Antibodies

Background: Convalescent plasma is one of the treatment options for COVID-19 which is currently being investigated in many clinical trials. Understanding of donor and product characteristics is important for optimization of convalescent plasma. Methods: Patients who had recovered from CO­VID-19 were recruited as donors for COVID-19 convalescent plasma (CCP) for a randomized clinical trial of CCP for treatment of severe COVID-19 (CAPSID Trial). Titers of neutralizing antibodies were measured by a plaque-reduction neutralization test (PRNT). Correlation of antibody titers with host factors and evolution of neutralizing antibody titers over time in repeat donors were analysed. Results: A series of 144 donors (41% females, 59% males; median age 40 years) underwent 319 plasmapheresis procedures providing a median collection volume of 850 mL and a mean number of 2.7 therapeutic units per plasmapheresis. The majority of donors had a mild or moderate course of COVID-19. The titers of neutralizing antibodies varied greatly between CCP donors (from <1:20 to >1:640). Donor factors (gender, age, ABO type, body weight) did not correlate significantly with the titer of neutralizing antibodies. We observed a significant positive correlation of neutralization titers with the number of reported COVID-19 symptoms and with the time from SARS-CoV-2 diagnosis to plasmapheresis. Neutralizing antibody levels were stable or increased over time in 58% of repeat CCP donors. Mean titers of neutralizing antibodies of first donation and last donation of repeat CCP donors did not differ significantly (1:86 at first compared to 1:87 at the last donation). There was a significant correlation of neutralizing antibodies measured by PRNT and anti-SARS-CoV-2 IgG and IgA antibodies which were measured by ELISA. CCP donations with an anti-SARS-CoV-2 IgG antibody content above the 25th percentile were substantially enriched for CCP donations with higher neutralizing antibody levels. Conclusion: We demonstrate the feasibility of collection of a large number of CCP products under a harmonized protocol for a randomized clinical trial. Titers of neutralizing antibodies were stable or increased over time in a subgroup of repeat donors. A history of higher number of COVID-19 symptoms and higher levels of anti-SARS-CoV-2 IgG and IgA antibodies in immunoassays can preselect donations with higher neutralizing capacity.

A retrospective study assessing the characteristics of COVID-19 convalescent plasma donors and donations.

BackgroundAlthough many trials are currently investigating the safety and efficacy of convalescent plasma (CP) in critically ill COVID‐19 patients, there is a paucity of ongoing and published studies evaluating the CP donors' side. This retrospective study reports the first Italian experience on CP donors' selection and donations.MethodsPatients aged 18‐68 years who had recovered from COVID‐19 at least 2 weeks previously were recruited between March 18 and June 30, 2020 in a study protocol at the Italian hospitals of Pavia and Mantova.ResultsDuring the study period, 494 of 512 donors recruited were judged eligible and underwent 504 plasmapheresis procedures. Eighty‐five percent (437/512) of the CP donors were males. The average time between symptom recovery and CP donation was 36.6 (±20.0) days. Four hundred and eighty‐eight plasmapheresis procedures (96.8%) were concluded and each unit was divided into two subunits (total 976) with an average volume of 316.2 (±22.7) mL. Ninety‐three percent (460/494) of CP donors at the time of plasma donation had a neutralizing IgG titer ≥1:80. Plasmapheresis‐related adverse reactions occurred in 2.6% (13/504) of cases; all the reactions were mild and none required therapeutic intervention. Donors' age and COVID‐19 severity were positively associated with greater antibody responses.ConclusionThis study demonstrates the feasibility and safety of a pilot CP program conducted in Italy. The identification of factors (ie, age and severity of COVID‐19) positively associated with higher neutralizing antibody titers at the time of donation may help to optimize the selection of CP donors.

Optimising plasmapheresis procedure: The role of plasma unit weight setting

The AUSL-IRCCS of Reggio Emilia Transfusion Unit operates in two blood donor centers. Plasmapheresis protocols and machines are identical in both centers, except for the final unit weight setting: 700 g in Center 1 and 720 g in Center 2. Within a wider study to assess the anticoagulant content in plasma units through proton nuclear magnetic resonance, we compared the efficiency of the two settings. We analyzed 215 and 100 consecutive samples from Centers 1 and 2, respectively. We collected processed blood volume, net plasma collected and anticoagulant volume in the plasma units. In our experience, setting the machine at 720 g instead of 700 g was associated with a small increase in plasma content of the final unit (only 4 mL), but implied an increase of more than 100 mL of the total processed blood and a higher amount of anticoagulant in the unit. On the contrary, the difference in donor's reinfused anticoagulant was negligible.Our findings come from an observational study suggesting that, in view of a minimal advantage in terms of collected net plasma, there might be relevant disadvantages for the donor in prolonging plasmapheresis over 700 g. Since observed differences may be attributed to confounding factors, we recommend always checking the marginal efficiency of the procedure when the balance target value of the setting is increased. Randomized cross-over studies are needed to find the optimal target weight for plasma units. These studies could also help defining personalized plasmapheresis procedures, thus further optimizing donor safety.

Features of the medical history and pregnancy outcomes in women with antiphospholipid syndrome depending on correction methods

Hypothesis/aims of study. The aim of this study was to evaluate the features of the medical history and pregnancy outcomes in women with miscarriage and antiphospholipid syndrome depending on the methods of its correction.&#x0D; Study design, materials and methods. A prospective cohort study was conducted, in which a total of 137 pregnant women with a history of abortion and antiphospholipid syndrome were examined. The women were divided into two groups according to the principle of the presence or absence of plasmapheresis procedures in the scheme of miscarriage therapy at the pregravid stage. Group I (main) consisted of individuals (n = 73), who were treated with the inclusion of plasmapheresis at the pregravid stage; group II (comparison) included women (n = 64), who were not given efferent therapy.&#x0D; Results. Antiphospholipid syndrome was more common in patients with a complicated obstetric and gynecological history. As a result of persistent infection, chronic endometritis and salpingo-ooparitis were more often observed in patients with TORCH infection. The titer of antiphospholipid antibodies, regardless of the presence or absence of TORCH infection, decreased after plasmapheresis, such positive dynamics being observed only in patients with a history of gestational losses of less than four.&#x0D; Conclusion. The level of reduction of antiphospholipid antibodies in relation to the initial values was 6095%, which indicates the optimal choice of the characteristics of plasmapheresis therapy and its duration.

PND75 VALIDATION OF AN ALGORITHM IDENTIFYING RELAPSES IN MULTIPLE SCLEROSIS USING THE FRENCH NATIONWIDE CLAIMS DATABASE

Although the main limitation of the French nationwide claims database (SNDS) is the absence of clinical information, relapse is an outcome that can be identified to assess effects of disease modifying therapies in multiple sclerosis (MS) in real word setting. The objective of this study was to assess the validity of an algorithm identifying relapses in MS patients in SNDS. A random sample of 200 patients - 100 with at least one relapse and 100 without relapse screened by the algorithm - were randomly selected from a cohort of 37,986 MS patients previously identified in the SNDS. For each case, all data available in the SNDS, in particular those related to the dispensing of corticosteroids, hospitalizations for potential MS relapse or for administration of high dose of steroids and plasmapheresis procedures were examined by 2 neurologists to assess the presence or absence of relapses, blind to the result of the algorithm. In the event of an inter-expert discrepancy, the summary sheets were reviewed in a collegiate manner, in order to reach a consensus. Algorithm performance was estimated using the positive and negative predictive values (PPV, NPV). Among the 200 patients randomly selected- 100 with at least one relapse and 100 without relapse - the algorithm correctly detected 95% patients with relapses (PPV) and 96% of patients without relapses (NPV). This claim-based algorithm appeared to successfully detect MS relapse and could thus be applied to future observational MS studies in SNDS. It could be secondarily revised to include all changes proposed by the experts in order to optimize its performance.

Application of biological age assessment of Chinese population in potential anti-ageing technology

BackgroundThis study aimed to construct a biological age assessment formula for the Chinese population and to explore the effectiveness of double filtration plasmapheresis for anti-ageing and longevity.Methods915 subjects were recruited, including 584 (63.8%) males and 331 females (36.2%). Male age was 50.94±10.60 (mean±SD), and female age was 51.20±11.84 (mean±SD). 34 blood markers were detected in the laboratory. The ageing biomarkers were determined by statistical correlation analysis and redundancy analysis, and the biological age assessment formula was established by multiple linear regression analysis. Paired sample T test was used to analyse the elimination effect of double filtration plasmapheresis on aging biomarkers.ResultsBased on the comprehensive blood test and analysis, the ageing biomarkers were screened, and the male and female biological age assessment formulas were established. Then, the elimination of ageing biomarkers by double filtration plasmapheresis was examined. Double filtration plasmapheresis can eliminate ageing biomarkers, with an average of 4.47 years decrease in age for males and 8.36 years for females.ConclusionSo, biological age provides a scientific tool for assessing ageing, and double filtration plasmapheresis is safe and might be effective for anti-ageing and longevity. However, the effect of plasmapheresis is expected to be transient, so further studies are needed to plan the number and range of the plasmapheresis procedures necessary to consistently lower the parameters under study.

Apheresis causes complement deposition on red blood cells (RBCs) and RBC antigen alterations, possibly inducing enhanced clearance.

Apheresis is increasingly being applied to collect cells or plasma, even allowing the collection of multiple blood components during one procedure. Although the quality of the cellular and plasma products that are obtained by apheresis have been extensively studied and shown to be of high quality, the impact of apheresis on the red blood cells (RBCs) that are returned to the donor has not been investigated. The effect of the plasma- or plateletpheresis procedures by four different devices-MCS+ (Haemonetics), PCS2 (Haemonetics), Trima Accel (Terumo BCT), and Autopheresis-C (Auto-C, Fresenius Kabi)-on the RBCs that are returned to the donor was tested in a blinded, prospective trial in a cohort of 25 donors. A rheologic analysis of donor RBCs before and after plasma- or plateletpheresis showed no differences in outcome. However, a strong increase in hemolysis was found in samples from the Trima Accel devices after plateletpheresis, compared to all other machines tested. Furthermore, an increase in complement deposition on RBCs was seen after all plasmapheresis procedures (MCS+, PCS2, and Auto-C). Finally, a significant decrease in the expression of the complement-regulating protein CD59 was seen in all postapheresis samples as well as a significant decrease of the adhesion molecule CD147. The increase in complement deposition and the decrease in the expression of CD59 suggests that RBC clearance might be enhanced after return to the donor. Possible side effects due to an increase in hemolysis after Trima Accel plateletpheresis should be further investigated.

The effects of repeated automated plasmapheresis in goats (Capra hircus) in response to vaccination with purified influenza hemagglutinin proteins.

Seasonal influenza is a contagious respiratory illness that annually affects millions of people worldwide. To identify currently circulating influenza virus subtypes, the Centers for Disease Control and Prevention’s International Reagent Resource distributes the World Health Organization (WHO) influenza reagent kits, which are used globally by testing laboratories for influenza surveillance. The data generated by the kits aid in strain selection for the influenza vaccine each season. The use of animals to produce high quality and quantities of antibodies is critical to the production of these kits. In this study, we assessed the effects and efficacy of repeated sampling from automated plasmapheresis in goats. Analysis of blood samples demonstrated that repeated automated plasmapheresis procedures did not adversely affect the immediate or long-term health of goats. Further, our results indicate that repeated plasmapheresis in goats was capable of generating 2 liters of antibody-rich plasma per goat per week. This volume is sufficient to produce enough WHO influenza kits to conduct over 1 million tests. Thus, we have shown that the rapid production of plasma in goats can positively impact the public health preparedness and response to influenza.

Plasmapheresis: A Retrospective Audit of Procedures from a Tertiary Care Center in Southern India.

Introduction:The term plasmapheresis/plasma exchange refers to the removal of the plasma component of blood and its replacement with various fluids. Plasma Exchange (PE) has been used to treat a variety of conditions that are associated with an aberrant immune response. We undertook this retrospective study aiming to look at plasmapheresis procedures conducted in the nephrology department over a fixed time period.Materials and Methods:Retrospective analysis of PE procedures from January 2013 to October 2016 was conducted in the nephrology and Intensive Care Unit of a tertiary care teaching hospital. The goal was to achieve a total removal of 150–200 ml/plasma per kg body weight. As replacement, we used a standard protocol of 100 ml of 20% albumin in 1 L of normal saline and 2–3 units of fresh frozen plasma. All results were expressed as mean ± standard deviation and statistical analysis was done using the Student's t-test for continuous and Fisher's exact test for categorical data.Results:A total of 192 procedures performed on 40 patients (22 males and 18 females). Age ranged from 15 to 79 years with a mean age of 37.5 years. Guillain–Barre syndrome accounted for 67.5% (>two-third of causes) for PE. Vascular access was femoral catheter in 27 (67.5%) and internal jugular catheter in 13 (32.5%). Mild hypotension occurred in 15 procedures (7.8%) of patients and allergic reactions such as rashes and chills occurred in 5 cycles (2.6%). A total of 36 patients (90%) showed significant improvement in condition, 2 did not show any change, while one worsened and one died due to respiratory complications.Conclusion:Our small series of data of plasmapheresis procedures from nephrology perspective has reaffirmed the safety and efficacy of the therapy in an experienced setup.

MODERN APPROACHES TO THERAPY OF GRAVE PSORIASIS FORMS

The article provides an overview of modern methods of psoriasis therapy. Presents the results of a study aimed at optimizing therapy for severe forms of psoriasis. Presents the developed algorithm for assigning plasmapheresis procedures depending on the form and clinical manifestations of the disease, as well as the developed practical recommendations of combined appointment of plasmapheresis and injections of methotrexate for severe psoriasis.

Plasmapheresis exerts a long-lasting antipruritic effect in severe cholestatic itch.

The amelioration of refractory cholestatic pruritus after plasmapheresis has been reported in single patients. Here, we analyse the efficacy of plasmapheresis in a cohort of patients with primary biliary cholangitis (PBC). Seventeen consecutive patients with PBC (age range 39-85years, 16 females, 9 with cirrhosis) and refractory pruritus underwent 129 plasmapheresis procedures during 40 admissions. Pruritus was quantified by the 10-point numeric rating scale (NRS) before and after plasmapheresis, as well as ~30 and ~90days later. The mean pruritus before plasmapheresis did not differ between patients with and without cirrhosis (P>.05). Cirrhotics presented, however, with significantly higher serum alanine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and bilirubin before plasmapheresis. Plasmapheresis decreased itching to NRS≤5 in all but five admissions: Mean pruritus decreased from 8.3±1.4 to 3.1±2.2 (P<.0001) in the entire cohort. It also led to a significant decrease in serum ALT, ALP, AST, GGT (all P<.001) and bilirubin (P=.002). Antipruritic effect persisted throughout the 90-days follow-up (P<.0001). The amelioration of pruritus was not affected by the presence of cirrhosis. Plasmapheresis is a promising method for reducing intractable itch in a significant proportion of PBC patients regardless of liver fibrosis. Long-lasting improvement of symptoms requires repeated procedures.

Plasmapheresis Is an Effective Approach Preventing Clinically Significant Tumor Lysis Syndrome during Induction Therapy in AML Patients with Hyperleukocytosis

Introduction. Most studies have found that hyperleukocytosis (HL >100*109/l) is a poor prognostic factor in acute myeloid leukemia (AML). It is diagnosed in 5-13 % of cases and is more common in AML with monocytes’ differentiation (M4, M5), as well as in cases with poor prognostic molecular markers, such as FLT3-ITD and others.According to the literature the early (during the first week) mortality in AML due to HL may reach 90%. The main cause of death are leukostasis, leading to neurological symptoms, respiratory distress syndrome (RDS) with lung lesions, disseminated intravascular coagulation (DIC) syndrome with the development life-threatening bleedings and massive tumor lysis syndrome during induction therapy.Aim. National Research Center for Hematology (NRCH) has initiated a prospective clinical study aiming to develop a feasible clinical approach preventing severe tumor lysis syndrome during induction in AML patients with initial WBC >100*109/l by using serial plasmapheresis (PA).Patients and Methods. From Jan 2010 till June 2014, 92 patients with de novo AML were treated in the NRCH according to AML-10 protocol (ClinicalTrials.gov Identifier: NCT01587430). Initial white blood cell (WBC) count more than 100x109/l was detected in 18 patients (19,5%): median age - 38 y (17-56yy), M/F - 10/8, WBC - 130x109/l (100-408x109/l), LDH -1765 µ/l (720-6653). 2 patients were in the favorable, 13 – in the intermediate, 2 - in the poor cytogenetic risk group. 83,3% (15/18) patients had hepatosplenomegaly and lymphadenopathy, 38.8 % (7/18) - gingival hyperplasia, 16,6 % (3/18) - neuroleukemia, 16,6% (3/18) - skin leukemids. All patients had infectious complications at diagnosis.Lung infiltrates due to leukostasis were revealed - in 77,8% (14/18), including 5 patients (27,8%) with RDS; neurological symptoms (headache, blurred consciousness) - in 33,3% (6/18), DIC syndrome - in 8/18 (44,4%) with 1 intracranial hemorrhage.All patients received allopurinole 600 mg/day. PA procedures were started during cytoreductive therapy (hydroxyurea 10 mg/kg/day 1-2 days) sometimes with leukapheresis (LA) and were continued within 1 or 2 days of conventional 7+3 (ARA-C 100 mg/m2 bid iv 1-7 d, DNR 60 mg/m2 x 3d) 2 hours after short (30 min) ARA-C infusion. DNR was applied on days 3 to 5 or 5 to 7, thus PA did not interfere with its pharmacokinetic properties. All patients concomitantly have got intensive hydrating (3-4 l) and diuretic therapy with electrolytes and albumin support.Results: Cytoreductive therapy with hydroxyurea was used for a median 2 days (1-7 dd). Half of the patients (9/18) have got 1-2 procedures of LA (median 2). Median 2 (1-4) procedures of PA were performed in 17/18 patients. The volume of removed plasma for 1 PA procedure was 1200 ml (900-1500 ml), the volume of compensation was – plasma 1100 ml (500-1600 ml) +/- 20% albumin 50-150,0 and 0,9% NaCl 500-1000,0.Median WBC count after cytoreductive therapy at the 1st day of 7+3 was 60x109/l (5,6-124x109/l). DNR was administered on days 5-7 in 16 and on days 3-5 - in 2 patients. No severe cytolysis with the development of multiple organ failure was observed. Only 1 patient with massive extramedullary involvement has developed just laboratory signs of acute renal failure without stopping the urinary function. Less than third of the patients (5/18) developed the transient signs of volemic overload within the first days of chemotherapy treated successfully with diuretics and plasmapheresis.CR after the 1st induction was achieved in 50% of (9/18) patients. Additional 7 patients achieved CR after the 2nd induction, resulting in 89% overall CR rate. Only 1 patient (5,5%) died with severe infectious complications during aplasia. Allogeneic bone marrow transplantation was performed in 8 of 16 CR patients. The median OS and DFS was 28 and 23 months, 3-years OS and DFS was 32% and 35% respectively.Conclusions. Our small study brought us to a conclusion that serial PA procedures during cytoreductive phase and the first days of 7+3 may prevent the development of tumor lysis syndrome and its complications. This clinical approach is feasible, easy to perform and decreases early mortality. DisclosuresNo relevant conflicts of interest to declare.