Response of patients with IgM and IgA-associated peripheral polyneuropathies to "off-line" immunoadsorption treatment using the Prosorba (R) protein A column

Sensory or sensorimotor demyelinating polyneuropathies may be associated wi th monoclonal immunoglobulins (paraproteins). Our prior experience suggests that "off-line" Prosorba(R) column treatments may be effective therapy for patients with polyneuropathies associated with paraproteins of the IgG cla ss. We report herein the treatment, using Prosorba(R), of 2 patients with p eripheral neuropathies and paraproteins of the IgM class and 1 patient with peripheral neuropathy whose paraprotein was of the IgA class. All three pa tients were treated "off-line" with Prosorba(R) six times in a 2-week perio d. Each time they were phlebotomized 1 U of whole blood. The plasma and red cells were separated in the blood bank. The plasma was passed over the col umn while the red blood cells were returned to the patient through a hepari n lock. Then the treated plasma was returned separately. There were no adve rse effects of treatment, and, in one patient with an IgM paraprotein and o ne with an IgA paraprotein, neurological symptoms and signs improved over t he subsequent 2 weeks. Prosorba(R) appears effective for predominantly sens ory demyelinating polyneuropathies associated with M-components of all majo r immunoglobulin classes. Our current experience further suggests that the mechanism of action of Prosorba(R) may not depend on removal of small amoun ts of IgG-containingiminune complexes from patients' plasma. A proper large -scale clinical trial is warranted. J. Clin. Apheresis 14:159-162, 1999. (C ) 1999 Wiley-Liss, Inc.