Therapeutic Plasma Exchange: For Cancer Patients

Figures & data

Table 1 The Different Ways of Therapeutic Plasma Exchange

Modalities	The Molecular Weight of the Removed Component	Indication	Alternative Solution	Efficiency	Specificity
Plasma exchange (PE)	Small and large molecules no larger than a few million Daltons	·Thrombotic microangiopathy (TMA) ·Acute liver failure ·Diseases of the nervous system ·Myeloma cast nephropathy	• Fresh frozen plasma (FFP) • 4–6% Albumin solution	High	Low
Double-filtration plasmapheresis (DFPP)	A relatively large molecule in plasma	Hyperviscosity syndrome (HVS)	Usually a solution of albumin	Middle	Middle
Plasma adsorption (PA)	Selective adsorption, such as autoantibodies, immune complexes, etc	·Myasthenia gravis (MG) ·Guillain Barre syndrome (GBS)	–	Low	High

Figure 1 The principle of plasma exchange (PE). The blood is separated from the body, processed and then passed through a single plasma separator. The filtered blood components are returned to the body together with the replacement fluid.

Figure 2 The principle of double filtration plasmapheresis (DFPP). The blood passed through the plasma separator and then passed through the plasma fractionator, and the filtered components were also returned to the human body after being combined with the replacement solution.

Figure 3 The principle of plasma adsorption (PA). Blood that has gone through a plasma separator is washed out of the blood with selective adsorbents and returned directly to the body.

Table 2 Indications for TPE in Patients with Cancer

Disease	Indication	Category	Grade^a
MCS		II	2B
HVS	Symptomatic	I	1B
	Prophylaxis for rituximab	I	1C
MG	Acute, short-term treatment	I	1B
	Long-term treatment	I	2B
PNS		III	2C
LEMS		II	2C
NMDAR		I	1C

Notes: ^aDigital representation the strength of recommendation: strong 1 vs weak 2; the letters denote the strength of evidence support, A, B, C respectively represents high, middle and low evidence support.

Table 3 Report on TPE for Cisplatin Overdose

Age	Sex	Cancer Types	Dosage	Treatment	IC	FC	Outcome	Reference
59	M	Esophageal carcinoma	300 ng/m^2	TPE+ GM-GSF	2979 ng/mL	185 ng/mL	Renal function recovered and partial remission of esophageal cancer was achieved	[^Citation116]
68	F	Ovarian cancer	280 ng/m2	TPE+HD+ GM-GSF+ Prednisone	2900 ng/mL	200 ng/mL	Hearing loss, no signs of recurrence of ovarian cancer	[^Citation117]
48	M	Laryngeal carcinoma	400 ng/m2	TPE+HD	2470 ng/mL	216 ng/mL	Full recovery without sequelae	[^Citation118]
63	M	Lymphoma	Total 750mg	TPE+HD+ N-acetylcytosine	–	–	Death	[^Citation115]
46	F	NSCLC	225 ng/m2	TPE+ Supportive care	–	–	Full recovery without sequelae	[^Citation119]
67	M	Esophageal carcinoma	240 ng/m2	TPE+ Intravenous hydration+ Chemical protectant	2350 ng/mL	110 ng/mL	There were no significant complications and only moderate hearing loss	[^Citation120]
13	F	Osteosarcoma	240 ng/m2	TPE+Chemical protectant	8500 ng/mL	110 ng/mL	He regained impaired kidney function and hearing	[^Citation121]

Abbreviations: IC, initial concentration, the initial plasma concentration of cisplatin; FC, final concentration, the final plasma concentration of cisplatin; M, male; F, female; HD, hemodialysis; GM-GSF, granulocyte macrophage colony stimulating factor; NSCLC, non-small cell lung cancer.

Table 4 Severity of Adverse Events

Grade	Severity	Treatment Requires	Classical Symptom
Grade I	Mild	No intervention required	Week of mouth sting
Grade II	Moderate	Need intervention but can complete treatment	·Paresthesia, ·Mild hypotension, ·Nausea, ·Urticaria
Grade III	Severe	Procedure interrupted or abandoned	·Prolonged vagal response time, ·Decreased level of consciousness, ·Muscle contractions, ·Hand and foot convulsions, ·Seizures, ·Arrhythmia
Grade IV	Fatal	Lethality	No response to treatment

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