HYPERVISCOSITY SYNDROME - EFFICACY AND COMPARISON OF PLASMA-EXCHANGE BY PLASMA SEPARATION AND CASCADE FILTRATION IN PATIENTS WITH IMMUNOCYTOMA OF WALDENSTROMS TYPE

The hyperviscosity syndrome is a common problem in patients suffering from IgM paraproteinemia. In this situation cytotoxic chemotherapy alo ne is insufficient and additional plasma therapy is required. Until re cently, conventional plasma exchange was the only plasma therapy avail able. While this method has proven its efficacy, it eliminates protein s unselectively. Cascade filtration, on the other hand, has been estab lished to remove proteins as a function of their size offering the pro spect of a highly selective withdrawal of macromolecules. In the work presented, the efficacy of conventional plasma exchange and cascade fi ltration was evaluated performing both techniques at random in cases o f hyperviscosity syndrome due to immunocytoma of Waldenstrom's type (n = 11/group). In these patients, conventional plasma exchange decrease d plasma viscosity by 48%; cascade filtration was less effective (26%) , correlating with a smaller decrease of IgM (conventional plasma exch ange 42% vs cascade filtration 27%), The profile of other plasma prote ins studied did not change significantly with either treatment. Furthe rmore, we observed no differences regarding serious side-effects. In c onclusion, we could not demonstrate a superior effect of cascade filtr ation as compared to conventional plasma exchange in the treatment of hyperviscosity syndrome.