Effect of Early Plasmapheresis and High-Dose Cyclophosphamide Therapy in Goodpasture’s Syndrome

Euler, H. H.; Kleine, Lawrence J.; Gutschmidt, Hans J.; Herrlinger, J. D.

doi:10.1159/000430669

Cited by 6 publications

(2 citation statements)

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“…The idea of rebound utilization (also termed "stimulation-deletion" model [ 121) was successfully applied in some early case reports: myasthenia gravis [44], SLE [ 1 1 I, Goodpasture's syndrome [45], and pemphigus vulgaris [46,47]. It has been repeatedly discussed as a general possibility for improving the therapeutic results in severe autoimmune diseases [ 12, [33][34][35]39,.…”

Section: Introductionmentioning

confidence: 99%

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: Design of the LPSG trial

Clark

Dau

Euler

et al. 1991

J of Clinical Apheresis

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A group of clinics are collaborating in the Lupus Plasmapheresis Study Group (LPSG) to investigate whether repeated plasmapheresis prior to pulse cyclophosphamide improves the therapeutical results in severe systemic lupus erythematosus (SLE). The underlying rationale is the hypothesis that plasmapheresis 1) eliminates pathogenic autoantibodies and immune complexes and 2) induces compensatory lymphocyte activation via feedback mechanisms between circulating antibodies and their respective clones ("antibody rebound"). It should be possible to utilize this enhanced activity for increased clonal deletion if pulse cyclophosphamide is applied shortly after plasmapheresis. Accordingly, in a randomized study, the LPSG will be comparing the repeated application of pulse cyclophosphamide alone with a treatment involving repeated plasmapheresis prior to the cyclophosphamide pulses in severe SLE. A third arm of the study will be gathering experience with a more intensified procedure. This overview summarizes the most important details of the planned study.

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Section: Introductionmentioning

confidence: 99%

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: Design of the LPSG trial

Clark

Dau

Euler

et al. 1991

J of Clinical Apheresis

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“…activity might be a means for increasing the deletion of pathogenic clones if high-dose CYC is applied during enhanced activity, and hence, during increased vulnerability of these clones. This concept of "stimulation and deletion" (8) or "synchronization" (21)(22)(23)(24) was investigated experimentally (17), and has been successfully used in cases of myasthenia gravis (25), SLE (23,24,26), Goodpasture's syndrome (22), and pemphigus vulgaris (21). However, the degree of adherence to the underlying concept varied considerably.…”

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confidence: 99%

Treatment‐free remission in severe systemic lupus erythematosus following synchronization of plasmapheresis with subsequent pulse cyclophosphamide

Euler

Schroeder²,

Harten³

et al. 1994

Arthritis & Rheumatism

134

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Objective. To investigate the effect of an intensified treatment protocol synchronizing plasmapheresis with subsequent pulse cyclophosphamide for severe systemic lupus erythematosus (SLE).Methods. A protocol of plasmapheresis (3 X 60 mllkg) and subsequent high-dose pulse cyclophosphamide (36 mgkg) followed by 6 months of peroral immunosuppression was used to treat 14 patients with severe SLE.Results. Rapid improvement was achieved in all patients. Immunosuppressants, including corticosteroids, were withdrawn at month 6 in 12 patients. Eight patients continued without treatment for a mean observation period of 5.6 years (46-91 months).Conclusion. The results demonstrate that treatment-free clinical remission can be achieved in some patients with severe SLE.

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Synchronization of Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris

Euler¹

1987

Arch Dermatol

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Long-lasting and complete remission was obtained in a 48-year-old patient with refractory pemphigus vulgaris by an experimental treatment protocol that tries to synchronize plasmapheresis with subsequent pulse cyclophosphamide therapy. The rationale of the approach tries to utilize the plasmapheresis-induced increased proliferation of pathogenic cell clones for partial deletion of these clones through application of maximum pulse immunosuppression treatment during the period of assumed maximum proliferation and, thus, maximum vulnerability of the antibody-producing cells. The treatment schedule consisted of initial withdrawal of immunosuppressive drug therapy, repeated large-volume plasmaphereses substituted with immunoglobulin-free albumin solutions, subsequent application of high-dose (36 mg/kg of body weight) cyclophosphamide therapy, and low-dose maintenance immunosuppression for several months. As a result, our patient remained disease free over a follow-up period of 40 months without any further immunosuppressive treatment. Stimulation of postexchange antibody production and subsequent application of high-dose cytotoxic drugs might be a valuable tool in the management of refractory pemphigus vulgaris and, possibly, in the management of other autoantibody-mediated diseases.

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Effect of Early Plasmapheresis and High-Dose Cyclophosphamide Therapy in Goodpasture’s Syndrome

Cited by 6 publications

References 0 publications

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: Design of the LPSG trial

Plasmapheresis and subsequent pulse cyclophosphamide versus pulse cyclophosphamide alone in severe lupus: Design of the LPSG trial

Treatment‐free remission in severe systemic lupus erythematosus following synchronization of plasmapheresis with subsequent pulse cyclophosphamide

Synchronization of Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris

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