Experience with protein A-immunoadsorption in treatment-resistant adult immune thrombocytopenic purpura

Abstract

Extracorporeal immunoadsorption of plasma to remove IgG and circulating immune complexes (CIC) was evaluated as a therapy for adults with treatment-resistant immune thrombocytopenic purpura (ITP). Seventy-two patients with initial platelet counts less than 50,000/microL who had failed at least two other therapies were studied. They received an average of six treatments of 0.25 to 2.0 L plasma per procedure over a 2- to 3-week period using columns of staphylococcal protein A-silica (PROSORBA immunoadsorption treatment columns; IMRE Corp, Seattle, WA). The treatments caused an acute increase in the platelet count to greater than 100,000/microL in 18 patients and to 50,000 to 100,000/microL in 15 patients. The median time to response was 2 weeks. Responses were transient (less than 1 month duration) in seven of those patients (10%), but no additional relapses were reported over a follow- up period of up to 26 months (mean of 8 months). Clinical responses were associated with significant decreases in specific serum platelet autoantibodies (including anti-glycoprotein IIb/IIIa), platelet- associated Ig, and CIC. Thirty percent of treatments were associated with transient mild to moderate side effects usually presenting as a hypersensitivity-type reaction. Continued administration of failed therapies for ITP, which always included low-dose corticosteroids (less than or equal to 30 mg/d), had no demonstrable influence on the effectiveness of immunoadsorption treatment but did depress the incidence and severity of side effects. The degree of effectiveness of protein A immunoadsorption therapy in patients with treatment-resistant ITP is promising and further controlled studies in this patient population are warranted.

How Prosorba Apheresis Came to Be Used for Rheumatoid Arthritis: A Personal Historical Perspective

“…After approval for ITP was granted by the Food and Drug Administration in 1987, Imre launched a Save the Spleen (I still have the packet!) campaign showing 40 to 50% response rates for adult chronic ITP, adult acute ITP, pediatric/adolescent ITP, and HIV associated thrombocytopenia (14). Interestingly, some of the patients in these studies also had systemic lupus.…”

Immunoadsorption with tryptophan columns: A therapeutic option for the treatment of rheumatoid arthritis with septic complications

“…Immunoadsorption has been used in the treatment of many autoimmune diseases, which remain unresponsive to other therapies. Idiopathic thrombocytopenic purpura, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and myasthenia gravis are examples of autoimmune disorders with good response on treatment with extracorporeal therapy [5][6][7][8]. The bridging of infectious complications described here has similarities with using immunoadsorption for infectious complications in severe pemphigus, which has been also successfully done with tryptophan immunoadsortion [9].…”

Heparin‐induced coagulopathy associated with staphylococcal protein A immunoadsorption treatment columns: an in vitro and in vivo analysis

“…SPA column immunoadsorption therapy has been shown to have a 30‐ to 50‐percent response rate in the treatment of refractory ITP 3 . This therapy is generally indicated in patients with ITP who have failed at least two therapies, that is, steroids and an immunosuppressive chemotherapeutic regimen, and have platelet counts less than 50 × 10 9 per L. To prevent the activation of coagulation as plasma comes in contact with the silica matrix in the column, heparinized saline is used to prime the column.…”

“…Immunoadsorption therapy using staphylococcal protein A (SPA) columns removes IgG (IgG 1 , IgG 2 , IgG 4 ) and IgG‐containing, circulating immune complexes from plasma 1,2 . Clinical studies indicate that this therapy is 30 to 50 percent effective in the treatment of refractory idiopathic thrombocytopenia purpura (ITP) 3 . Several studies have shown that this therapy may be effective in the treatment of refractory alloimmune thrombocytopenia and in the management of refractory rheumatoid arthritis 4–7 …”