Beneficial Plasma Exchange Response in Central Nervous System Inflammatory Demyelination
Setty M. Maga?a, BS; B. Mark Keegan, MD; Brian G. Weinshenker, MD; Bradley J. Erickson, MD, PhD; Sean J. Pittock, MD; Vanda A. Lennon, MD, PhD; Moses Rodriguez, MD; Kristine Thomsen, BA; Stephen Weigand, MS; Jay Mandrekar, PhD; Linda Linbo, RN; Claudia F. Lucchinetti, MD
Arch Neurol.?Published online March 14, 2011. doi:10.1001/archneurol.2011.34
Background? Plasma exchange (PLEX) is a beneficial rescuetherapy for acute, steroid-refractory central nervous systeminflammatory demyelinating disease (CNS-IDD). Despite the approximately45% PLEX response rate reported among patients with CNS-IDD,determinants of interindividual differences in PLEX responseare not well characterized.
Objective? To perform an exploratory analysis of clinical,radiographic, and serological features associated with beneficialPLEX response.
Design? Historical cohort study.
Setting? Neurology practice, Mayo Clinic College of Medicine,Rochester, Minnesota.
Patients? All Mayo Clinic patients treated with PLEX betweenJanuary 5, 1999, and November 12, 2007, for a steroid-refractoryCNS-IDD attack.
Main Outcome Measure? The PLEX response in attack-related,targeted neurological deficit(s) assessed within the 6-monthperiod following PLEX.
Results? We identified 153 patients treated with PLEX fora steroid-refractory CNS-IDD, of whom 90 (59%) exhibited moderateto marked functional neurological improvement within 6 monthsfollowing treatment. Pre-PLEX clinical features associated witha beneficial PLEX response were shorter disease duration (P?=?.02)and preserved deep tendon reflexes (P?=?.001); post-PLEXvariables included a diagnosis of relapsing-remitting multiplesclerosis (P?=?.008) and a lower Expanded DisabilityStatus Scale score (P?< ?.001) at last follow-up. Plasma exchange was less effective for patients with multiplesclerosis who subsequently developed a progressive disease course(P?=?.046). Radiographic features associated witha beneficial PLEX response were presence of ring-enhancing lesions(odds ratio?=?4.00; P?=?.03) and/or masseffect (odds ratio?=?3.00; P?=?.02). Noassociation was found between neuromyelitis optica–IgGserostatus and PLEX response.
Conclusions? We have identified clinical and radiographicfeatures that may aid in identifying patients with fulminant,steroid-refractory CNS-IDD attacks who are more likely to respondto PLEX.
Author Affiliations: Departments of Neurology (Mss Maga?a and Linbo and Drs Keegan, Weinshenker, Pittock, Lennon, Rodriguez, and Lucchinetti), Radiology (Dr Erickson), Laboratory Medicine and Pathology (Drs Pittock and Lennon), Immunology (Dr Lennon), and Health Sciences Research (Ms Thomsen, Mr Weigand, and Dr Mandrekar), Mayo Clinic College of Medicine, Rochester, Minnesota.