PLASMA-EXCHANGE IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Standard treatment for severe systemic lupus erythematosus (SLE) consi sts of corticosteroids and immunosuppressive drugs. A number of contro lled studies purport to show that parallel application of plasmapheres is is no longer tenable since it imparts no additional benefit. Three indications for plasmapheresis in SLE appear to remain: (1) emergency intervention; (2) contraindication of cytotoxic drugs in severe SLE; a nd (3) so-called ''synchronization'', which combines plasmapheresis wi th subsequent high-dose pulse cyclophosphamide and has achieved repeat edly long-term, treatment free remission in severe SLE. Immuno-adsorpt ion, especially employing an anti-immunoglobulin adsorber, appears to represent a further useful technological advance. It is questionable w hether photopheresis, lymphapheresis, and cascade filtration will have a role to play in the treatment of SLE. An additional indication for apheresis may be the new procedure of autologous transplantation of pu rged stem cells. Copyright (C) 1996 Elsevier Science Ltd.