Plasmapheresis is being used with considerable frequency in the management of malignant and non-malignant disorders. More recently,
staphylococcal Protein A immunoadsorption has been employed in similar clinical situations. In patients with
malignancy,
plasmapheresis has been shown to produce alterations in
plasma proteins, decrease circulating
immune complexes, remove "specific" and "non-specific" blocking factors, change immune reactivity, and affect monocyte function. Partial responses have been reported in a small number of patients with
carcinoma of lung, colon, and breast following
plasmapheresis. In addition, there are reports of favorable responses in patients with
melanoma, head and neck
tumors,
lymphomas,
leukemias, and
Kaposi's sarcoma in acquired immune deficiency. All these responses were partial and brief, and the treatment did not alter the course of the disease.
Plasmapheresis has been useful in the management of hyperviscosity and occasionally of
paraneoplastic syndromes. It may also have a role in the treatment of
thrombotic thrombocytopenic purpura associated with
mitomycin-C therapy.
Protein A immunoadsorption, by which circulating
immune complexes are selectively removed, can activate the
complement system, increase blastogenic responses, and increase the natural killer cell activity. It has been shown to produce partial responses in breast and
colon cancer, as well as
Kaposi's sarcoma in acquired immune deficiency. It may have a useful role to play in the management of
mitomycin-C-associated
thrombotic thrombocytopenic purpura. Both
plasmapheresis and
Protein A immunoadsorption should be considered investigational interventions at this time. Toxicity of
plasmapheresis, though uncommon, can be serious and may rarely be fatal. Toxicity of
Protein A immunoadsorption is mild, consisting mainly of
influenza-like symptoms and
rash.