[Plasma immunoadsorption treatment of malignant multiple sclerosis with severe and prolonged relapses].
BACKGROUND
The treatment of prolonged, severe relapses in multiple sclerosis (MS) patients who respond poorly to high-dose intravenous corticosteroids is not yet established. Plasma immunoadsortion (IA) removes immunoglobulins (IgG), immune complexes, and complement from plasma. It may bear some advantages compared to plasmapheresis, a nonselective procedure that requires substitution of patient plasma by colloids solutions or plasma, which may carry a potential risk for viral infections.


METHODS
Three relapsing-remitting MS patients with a malignant course received IA. All they were experiencing a prolonged relapse unresponsive to high-dose intravenous corticosteroids, causing a locked-in state in two of the patients and severe pseudobulbar impairment in the third one. Five to six IA consecutive sessions were administered along a 7-10 days course.


RESULTS
IA was followed by a prompt and unequivocal clinical response in all three patients, which paralleled a decrease in IgG, fibrinogen, and C3 complement serum levels. IA administration was followed by immunosuppressor therapy, either with cyclophosphamide and intravenous ACTH (2 cases) or mitoxantrone (1 case). Improvement has been sustained along a mean follow-up of 7.6 years (range: 7-8.5 years), only one of the patients suffering two mild clinical relapses.


CONCLUSIONS
We believe that IA may be useful, either as a coadyuvant or alternative treatment in severe relapses in MS patients that do not respond to high-dose intravenous corticosteroid therapy.
de Andrés
C
C
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Anaya
F
F
Giménez-Roldán
S
S
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003176:Complement C3 / Q000378:metabolism; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008942:Mitoxantrone / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000097:blood / Q000628:therapy*
D000970:Antineoplastic Agents; D003176:Complement C3; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D005340:Fibrinogen; D000324:Adrenocorticotropic Hormone; D008942:Mitoxantrone
Tratamiento con plasma inmunoadsorción en brotes graves y prolongados de esclerosis múltiple maligna.