Rheohemapheresis (Clinical Importance of Rheological, Technical and Further Hemapheretic Indicators of Effectivity; Side-effects and Economy)

SUMARY RHEOHEMAPHERESIS - Clinical Importance of Rheological, Technical and Further Hemapheretic Indicators of Effectivity , Side-effects and Economy INTRODUCTION: (Haema)rheopheresis combines the possibilities of haemapheresis (a therapeutic method that is focused on the separation of blood components) and medical rheology (a field of science studying blood fluidity and applying the results of this research to clinical practice in pathological impairments, mainly in the area of microcirculation). The rationale of the effect of rheopheresis (RF): the procedures simultaneously eliminate the exactly defined spectrum of rheologically relevant high-molecular proteins. An immediate pulse reduction of plasma viscosity and viscosity of full blood occurs, which can lead to subsequent permanent "recovery" of the microcirculation with the use of a series of procedures and significantly change the natural course of chronic therapy. RF has been tested in several diseases. This study involves the use of rheopheresis in the dry form of age-related macular degeneration (AMD) and sudden idiopathic sensorineural hearing loss - SISHL. The research was aimed at the optimisation of own modification of rheopheresis, effectivity of procedures, search for the markers of immediate efficacy and prognosis, evaluation of safety and...SOUHRN ÚVOD: (Hemo)reoferéza spojuje možnosti hemaferézy (léčebné metody, která se zabývá separací krevních složek) a lékařské reologie (vědní obor, studující krevní fluiditu a aplikující výsledky tohoto výzkumu do klinické praxe u patologických poruch hlavně v oblasti mikrocirkulace). Podstata účinku reoferézy (RF): procedury simultánně eliminují exaktně definované spektrum reologicky relevantních vysokomolekulárních proteinů. Dojde k okamžité pulzní redukci plazmatické viskozity i viskozity plné krve, což při použití série procedur může vést k následnému trvalému "recovery" mikrocirkulace a změnit signifikantně přirozený průběh chronické choroby. RF byla zkoušena u několika chorob, tato práce řeší využití reoferézy u suché formy věkem podmíněné makulární degenerace (VPMD) a náhlé idiopatické ztráty sluchu (Sudden idiopathic sensorineural hearing loss - SISHL). Výzkum byl zaměřen na optimalizaci vlastní modifikace reoferézy, efektivitu procedur, hledání ukazatelů okamžité účinnosti a prognózy, zhodnocení bezpečnosti a ekonomické stránky reoferézy. SOUBOR NEMOCNÝCH A METODIKA: Reoferézou bylo léčeno112 nemocných, z toho 71 nemocných s VPMD (41 žen a 30 mužů ve věku průměrně 67,0 let) a 41 nemocných se SISHL (14 žen a 27 mužů ve věku průměrně 56,0 let). Pro primární oddělení plazmy byl použit kontinuální...4th Department of Internal Medicine - HaematologyIV. interní hematologická klinikaLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Long-Term Outcomes of Rheohaemapheresis in the Treatment of Dry Form of Age-Related Macular Degeneration

Purpose. Determining long-term effects of rheohaemapheresis on the dry form of age-related macular degeneration. Methods. This study evaluates 19 patients, average age of 67.6 years, treated with rheohaemapheresis and 18 patients, average age of 72.8 years, comprising the control group. Minimum follow up period was 3.5 years. Each treated patient received a series of 8 sessions of rheohaemapheresis of 1.5 plasma volumes within 10 weeks. We measured the drusenoid pigment epithelium detachment (DPED), best-corrected visual acuity (BCVA), electroretinography (ERG), and rheological parameters. Results. In the treatment group, the baseline BCVA was 0.74 (0.36–1.0) 95% CI and BCVA after 3.5 years was 0.79 (0.41–1.0) 95% CI (P=0.726). In the control group, the baseline BCVA was 0.71 (0.15–1.0) 95% CI and BCVA after 3.5 years decreased to 0.7 (0.32–0.87) 95% CI (P=0.031). Baseline DPED was 6.78 ± 3.79 mm2; after 3.5 years, it decreased to 4.13 ± 3.84 mm2 (P<0.001). In the control group, the baseline DPED was 4.09 ± 3.48 mm2; after 3.5 years, it increased to 6.69 ± 4.2 mm2 (P=0.001). We noted increasing levels of positive wave peaking at 50 milliseconds (P50) after treatment (P=0.022) and a stable amplitude of photopic responses of treated patients. Conclusion. Over the long term, rheohaemapheresis reduced the DPED, improved the function of photoreceptors, and prevented the decline of BCVA

Preservation of the Photoreceptor Inner/Outer Segment Junction in Dry Age-Related Macular Degeneration Treated by Rheohemapheresis

Aim. To evaluate the long-term effect of rheohemapheresis (RHF) treatment of age-related macular degeneration (AMD) on photoreceptor IS/OS junction status. Methods. In our study, we followed 24 patients with dry AMD and drusenoid retinal pigment epithelium detachment (DPED) for a period of more than 2.5 years. Twelve patients (22 eyes) were treated by RHF and 12 controls (18 eyes) were randomized. The treated group underwent 8 RHF standardized procedures. We evaluated best-corrected visual acuity, IS/OS junction status (SD OCT), and macular function (multifocal electroretinography) at baseline and at 2.5-year follow-up. Results. RHF caused a decrease of whole-blood viscosity/plasma viscosity at about 15/12%. BCVA of treated patients increased insignificantly P=0.187 from median 74.0 letters (56.2 to 81.3 letters) to median 79.0 letters (57.3 to 83.4 letters), but it decreased significantly from 74.0 letters (25.2 to 82.6 letters) to 72.5 letters (23.4 to 83.1 letters) in the control group P=0.041. The mfERG responses in the region of eccentricity between 1.8° and 7° were significantly higher in treated patients P=0.04. Conclusions. RHF contributed to sparing of photoreceptor IS/OS junction integrity in the fovea, which is assumed to be a predictive factor for preservation of visual acuity

Rheohemapheresis (Clinical Importance of Rheological, Technical and Further Hemapheretic Indicators of Effectivity; Side-effects and Economy)

SUMARY RHEOHEMAPHERESIS - Clinical Importance of Rheological, Technical and Further Hemapheretic Indicators of Effectivity , Side-effects and Economy INTRODUCTION: (Haema)rheopheresis combines the possibilities of haemapheresis (a therapeutic method that is focused on the separation of blood components) and medical rheology (a field of science studying blood fluidity and applying the results of this research to clinical practice in pathological impairments, mainly in the area of microcirculation). The rationale of the effect of rheopheresis (RF): the procedures simultaneously eliminate the exactly defined spectrum of rheologically relevant high-molecular proteins. An immediate pulse reduction of plasma viscosity and viscosity of full blood occurs, which can lead to subsequent permanent "recovery" of the microcirculation with the use of a series of procedures and significantly change the natural course of chronic therapy. RF has been tested in several diseases. This study involves the use of rheopheresis in the dry form of age-related macular degeneration (AMD) and sudden idiopathic sensorineural hearing loss - SISHL. The research was aimed at the optimisation of own modification of rheopheresis, effectivity of procedures, search for the markers of immediate efficacy and prognosis, evaluation of safety and..

Rheopheresis in treatment of idiopathic sensorineural sudden hearing loss

Abstract Backround Only few therapeutic options exist for patients with refractory sudden idiopathic sensorineural hearing loss (SISHL). Little is known about the efficacy of second-line therapies. Rheopheresis seems to be an effective therapeutic possibility. Methods Between 2012 and 2015, 106 patients with SISHL were enrolled in the study, of whom 52 were refractory to initial treatment. As salvage therapy, these patients were offered either 3 sessions of rheopheresis (33 pts) or intratympanic steroid treatment through MicroWick application (19 pts). Pure tone audiometry was performed at diagnosis, at the 1st month and the 1st year during the follow-up. Results Patients in the rheopheretic arm had higher hearing loss than in the MicroWick arm (81% vs. 52%, p = 0.04). In spite of this, there was a significant improvement for patients in the rheopheretic arm (27% of hearing loss reduction, p < 0.001) after the 1st month and this remained unchanged during the 1st year, while no improvement was seen in the MicroWick arm (0% of hearing loss reduction, p = 0.424). We found no predictive factor for steroid-failure in first-line therapy. Older age (p = 0.003), presence of vertigo (p = 0.006) and more profound initial hearing loss (p < 0.001) were identified as negative prognostic markers. Conclusion Rheopheresis can be used as a potentially effective and safe salvage therapy for patients with cortico-refractory SISHL

Therapeutic Apheresis, Circulating PLD, and Mucocutaneous Toxicity: Our Clinical Experience through Four Years

Cancer treatment has been greatly improved by the combined use of targeted therapies and novel biotechnological methods. Regarding the former, pegylated liposomal doxorubicin (PLD) has a preferential accumulation within cancer tumors, thus having lower toxicity on healthy cells. PLD has been implemented in the targeted treatment of sarcoma, ovarian, breast, and lung cancer. In comparison with conventional doxorubicin, PLD has lower cardiotoxicity and hematotoxicity; however, PLD can induce mucositis and palmo-plantar erythrodysesthesia (PPE, hand-foot syndrome), which limits its use. Therapeutical apheresis is a clinically proven solution against early PLD toxicity without hindering the efficacy of the treatment. The present review summarizes the pharmacokinetics and pharmacodynamics of PLD and the beneficial effects of extracorporeal apheresis on the incidence of PPE during chemoradiotherapy in cancer patients

Dynamics of Blood Count after Rheohemapheresis in Age-Related Macular Degeneration: Possible Association with Clinical Changes

Background. Rheohemapheresis (RHF) is a method that can stop the activity of the dry form of age-related macular degeneration (AMD). The pathophysiologic mechanisms are not well understood, and the effects of the RHF procedures extend beyond the time of the individual procedures. Patients and Methods. We present the data for 46 patients with AMD treated with a series of 8 rheohemapheretic procedures. Blood count parameters were measured before the first and the last procedures. The clinical effect was judged by changes in the drusenoid pigment epithelium detachment (DPED) area before and after the rheopheretic sessions. Results. Rheopheresis caused a decrease in hemoglobin (P<0.001), a decrease in leukocytes (P<0.034), and an increase in platelets (P<0.005). We found a negative correlation between the amount of platelets and their volume (P<0.001, Pearson correlation coefficient: −0.509). We identified the platelet/MPV ratio as a good predictor of the clinical outcome. Patients with a platelet/MPV ratio greater than 21.5 (before the last rheopheresis) had a significantly better outcome (P=0.003, sensitivity of 76.9% and specificity of 80%). Conclusion. Several basic blood count parameters after RHF can be concluded to significantly change, with some of those changes correlating with the clinical results (reduction of the DPED area)

FIFTEEN YEARS OF SINGLE CENTER EXPERIENCE WITH STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA: A RETROSPECTIVE ANALYSIS

Introduction: Autologous stem cell transplantation (ASCT) became standard of care for patients with multiple myeloma (MM) under the age of 65 years. We routinely perform ASCT for newly diagnosed MM since 1996 in our department. Patients and methods: We retrospectively analyzed all 285 transplants in 185 patients done for MM from January 1996 till December 2010. We analyzed overall survival (OS) and progression-free survival (PFS) regarding conditioning, stage, complete or very good partial remission (CR, VGPR) achievement, renal impairment, single vs. double transplant. Results: Estimated 10-years survival of the whole set of patients is 39% (median survival 95 months). Patients with renal impairment show same OS as those without (p = 0.22). Patients show similar overall survival and event free survival regardless of type of transplant. We observed better outcome in terms of overall survival in patients treated with new drugs (p = 0.0014). Reaching CR or VGPR was not translated into better OS (p = 0.30) and EFS (p = 0.10). Also stage of the disease and whether single or double transplant was used did not make any significant difference in the outcome. Conclusion: Stem cell transplantation greatly improved outcome of patients with MM. Poor outcome of allogeneic transplantation in our group of patients is related to high transplant related mortality (20% vs. 0%) and unexpected high relapse rate. There is a trend towards better survival, when new drugs are incorporated at any time in the course of the disease. This fact supports hypothesis that use of these drugs with ASCT should translate into better long-term outcome