Therapeutic Apheresis, Immunosuppression, and Human Monoclonal Antibodies in Hematologic Diseases

Abstract

To cure a patient by removing his illness by extracting blood is a very old one. Now this old process, bloodletting, placed on a rational basis with therapeutic apheresis using hollow fiber membranes, is being our clinical practice. Based on many years of experience with extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in hematologic diseases, with immunologic or non-immunologic origin. Immunology and molecular biology of the different hematologic diseases are discussed in relation to the rationale for apheresis therapies, and its place alone or in combination with other modern therapies, such as immunosuppression, HMAs, tyrosine kinase inhibitors, recombinant factor VVII, VIII, and others. The prognosis of the most of the hematologic diseases has improved in recent years, due in part to very aggressive therapy methods. Therapeutic apheresis is indicated most only in severe hematologic diseases. The guidelines of the Apheresis Application Committee of the American Society for Apheresis for the hematologic diseases, which could be treated with apheresis methods are cited. Therapeutic apheresis has been shown to effectively remove autoantibodies, toxins, and other pathologic substances from blood and lead to rapid clinical improvement, and it can safely be performed even in all severe ill patients, most in combination with immunosuppression, and/or human monoclonal antibodies.