THERAPY OF COAGULATION-FACTOR-VIII AUTOANTIBODIES WITH LONG-TERM EXTRACORPOREAL PROTEIN-A ADSORPTION AND IMMUNOSUPPRESSION

Acquired factor VIII (FVIII) inhibitors in non-haemophiliacs may pose serious treatment problems. Materials and Methods: For IgG-adsorptions we utilized an automated plasma separation device and a plasma flow m onitor. Case reports: A 63-year old woman showed life-threatening blee ding because of an inhibitor. After stabilization by porcine FVIII thr ee cycles of a modified Malmoe treatment protocol were applied, follow ed by long-term cyclophosphamide p.o. and weekly IgG-adsorptions. With in twelve months the patient exhibited a complete remission. A 54-year old man presented a comparable history. Because of a good response af ter the first cycle he was subsequently switched to the longterm thera py. Up to now (> 7 months) FVIII activities and inhibitor titers remai ned stable (10-20% rsp. < 3 BU/ml). In both cases no FVIII substitutio n therapy was necessary. Conclusions: A modified Malmoe protocol combi ned with long-term cyclophosphamide p.o. and weekly IgG-adsorptions se ems to be all efficient, safe and cost-effective regimen for non-haemo philiacs with FVIII inhibitors. (C) 1998 Elsevier Science Ltd. All rig hts reserved.