THERAPY FOR PARANEOPLASTIC NEUROLOGIC SYNDROMES IN 6 PATIENTS WITH PROTEIN-A COLUMN IMMUNOADSORPTION

Background. Paraneoplastic neurologic syndromes, although rare, cause significant morbidity and mortality. They are thought to be immunologi cally mediated, but to date those involving the central nervous system (CNS) have not been particularly responsive to immunologic therapy. T he use of the novel immunomodulator, protein A immunoadsorption, was e xplored to address this question. Methods. Six patients with neurologi c paraneoplastic syndromes were treated with this technique, using the ''off line'' method. Two hundred fifty mi of plasma was perfused thro ugh a column containing protein A covalently attached to a silica matr ix. The plasma was then returned to the patient. Results. Five of the patients responded to the therapy, with complete and durable responses in three patients with opsoclonus-myoclonus, objective, though transi ent, improvement in one patient with paraneoplastic brainstem encephal itis associated with a Merkel cell tumor, and stabilization and partia l improvement in one patient with paraneoplastic limbic encephalitis. The patient without response developed a cutaneous vasculitis after th e second treatment, and therapy was discontinued. Conclusions. This th erapy appears beneficial for a number of paraneoplastic syndromes, mos t dramatically in the opsoclonus/myoclonus syndrome.