PLASMAPHERESIS AND SUBSEQUENT PULSE CYCLOPHOSPHAMIDE IN SEVERE SYSTEMIC LUPUS-ERYTHEMATOSUS - AN INTERIM-REPORT OF THE LUPUS-PLASMAPHERESIS-STUDY-GROUP
Hh. Euler et L. Guillevin, PLASMAPHERESIS AND SUBSEQUENT PULSE CYCLOPHOSPHAMIDE IN SEVERE SYSTEMIC LUPUS-ERYTHEMATOSUS - AN INTERIM-REPORT OF THE LUPUS-PLASMAPHERESIS-STUDY-GROUP, Annales de medecine interne, 145(5), 1994, pp. 296-302
The rarity with which therapy-free remission is achieved in patients w
ith severe SLE demand the continued search for improved treatment stra
tegies. Possibly, therapeutic results can be improved by means of a ''
synchronized'' combination of plasmaphereses followed by pulse cycloph
osphamide (Ctx). If the hypothesis is correct, that plasmapheresis ind
uces a compensatory ''rebound'' proliferation of pathogenic clones, th
en pulse Ctx applied immediately after plasmapheresis should attack th
ese activated clones when they are most vulnerable and, ideally, elimi
nate them. Employing a strict variant of this strategy in a pilot stud
y, treatment-free remission lasting now for up to 7 years were achieva
ble in 8 of 14 SLE patients. The Lupus Plasmapheresis Study Group (LPS
G) is currently conducting a randomized international multicenter tria
l comparing a synchronized procedure with the administration of pulse
Ctx alone. The present paper explains the rationale of synchronization
and reports on the interim status of the LPSG Study.