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Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris: A Novelty or a Reappraisal?-Reply

Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris: A Novelty or a... Abstract In Reply.— The rationale behind the "synchronization" concept of plasmapheresis with subsequent pulse cyclophosphamide therapy is to utilize the increased vulnerability of pathogenic B cells by applying high-dose cytotoxic drugs shortly after antibody depletion during the period of maximum antibody rebound, ie, during the period of maximum depletion-induced B-cell proliferation and vulnerability. This basic concept was applied experimentally as early as 1971.1 It was first applied clinically in myasthenia gravis in 1980,2 in systemic lupus erythematosus in 1981,3 and in Goodpasture's syndrome in 1982.4 It was suggested for severe pemphigus5 in 1983, and it was first applied clinically in pemphigus vulgaris in one of seven briefly reported cases in a 1984 article by Ruocco and coworkers.6 We regret that none of us had seen that article.However, though the basic rationale is the same as in our report,7 there are some major differences concerning the strictness References 1. Bystryn JC, Schenkein I, Uhr JW: A model for the regulation of antibody synthesis by serum antibody , in Amos B (ed): Progress in Immunology , vol 1. Orlando, Fla, Academic Press Inc, 1971, pp 627-636. 2. Dau PC: Plasmapheresis therapy in myasthenia gravis . Muscle Nerve 1980;3:468-482.Crossref 3. Verrier Jones J, Robinson MF, Parciany RK, et al: Therapeutic plasmapheresis in systemic lupus erythematosus: Effect on immune complexes and antibodies to DNA . Arthritis Rheum 1981;24:1113-1120.Crossref 4. Euler HH, Kleine L, Gutschmidt HJ, et al: Effect of early plasmapheresis and high-dose cyclophosphamide therapy in Goodpasture's syndrome , in Beyer JH, Borberg H, Fuchs C, et al (eds): Plasmapheresis in Immunology and Oncology . New York, S Karger, 1982, pp 238-246. 5. Roujeau JC, Andre C, Revuz J, et al: Effects of various immunosuppressive regimens on the `rebound phenomenon' induced by plasma exchange in pemphigus , in Nosé Y, Malchesky PS, Smith JW, et al (eds): Plasmapheresis: Therapeutic Applications and New Techniques . New York, Raven Press, 1983, pp 285-292. 6. Ruocco V, Astarita C, Pisani M: Plasmapheresis as an alternative or adjunctive therapy in problem cases of pemphigus . Dermatologica 1984;168:219-223.Crossref 7. Euler HH, Löffler H, Christophers E: Synchronization of plasmapheresis and pulse cyclophosphamide therapy in pemphigus vulgaris . Arch Dermatol 1987;123:1205-1210.Crossref 8. Stevenson HC, Fauci AS: Activation of human B lymphocytes: XII. Differential effects of in vitro cyclophosphamide on human lymphocyte subpopulations involved in B cell activation . Immunology 1979;39:391-397. 9. Schröder JO, Euler HH, Löffler H: Synchronization of plasmapheresis and pulse cyclophosphamide in severe systemic lupus erythematosus . Ann Intern Med 1987;107:344-346.Crossref 10. Euler HH, Schroeder JO, Gutschmidt HJ, et al: The antibody rebound phenomenon as a rationale for synchronizing plasmapheresis with pulse cytotoxic drugs , in Oda T, Shiokawa Y, Inoue N (eds): Proceedings of the First International Congress of the World Apheresis Association: Therapeutic Plasmapheresis . Cleveland, International Society for Artificial Organs Press, 1987, pp 200-207. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris: A Novelty or a Reappraisal?-Reply

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1988.01670110073019
Publisher site
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Abstract

Abstract In Reply.— The rationale behind the "synchronization" concept of plasmapheresis with subsequent pulse cyclophosphamide therapy is to utilize the increased vulnerability of pathogenic B cells by applying high-dose cytotoxic drugs shortly after antibody depletion during the period of maximum antibody rebound, ie, during the period of maximum depletion-induced B-cell proliferation and vulnerability. This basic concept was applied experimentally as early as 1971.1 It was first applied clinically in myasthenia gravis in 1980,2 in systemic lupus erythematosus in 1981,3 and in Goodpasture's syndrome in 1982.4 It was suggested for severe pemphigus5 in 1983, and it was first applied clinically in pemphigus vulgaris in one of seven briefly reported cases in a 1984 article by Ruocco and coworkers.6 We regret that none of us had seen that article.However, though the basic rationale is the same as in our report,7 there are some major differences concerning the strictness References 1. Bystryn JC, Schenkein I, Uhr JW: A model for the regulation of antibody synthesis by serum antibody , in Amos B (ed): Progress in Immunology , vol 1. Orlando, Fla, Academic Press Inc, 1971, pp 627-636. 2. Dau PC: Plasmapheresis therapy in myasthenia gravis . Muscle Nerve 1980;3:468-482.Crossref 3. Verrier Jones J, Robinson MF, Parciany RK, et al: Therapeutic plasmapheresis in systemic lupus erythematosus: Effect on immune complexes and antibodies to DNA . Arthritis Rheum 1981;24:1113-1120.Crossref 4. Euler HH, Kleine L, Gutschmidt HJ, et al: Effect of early plasmapheresis and high-dose cyclophosphamide therapy in Goodpasture's syndrome , in Beyer JH, Borberg H, Fuchs C, et al (eds): Plasmapheresis in Immunology and Oncology . New York, S Karger, 1982, pp 238-246. 5. Roujeau JC, Andre C, Revuz J, et al: Effects of various immunosuppressive regimens on the `rebound phenomenon' induced by plasma exchange in pemphigus , in Nosé Y, Malchesky PS, Smith JW, et al (eds): Plasmapheresis: Therapeutic Applications and New Techniques . New York, Raven Press, 1983, pp 285-292. 6. Ruocco V, Astarita C, Pisani M: Plasmapheresis as an alternative or adjunctive therapy in problem cases of pemphigus . Dermatologica 1984;168:219-223.Crossref 7. Euler HH, Löffler H, Christophers E: Synchronization of plasmapheresis and pulse cyclophosphamide therapy in pemphigus vulgaris . Arch Dermatol 1987;123:1205-1210.Crossref 8. Stevenson HC, Fauci AS: Activation of human B lymphocytes: XII. Differential effects of in vitro cyclophosphamide on human lymphocyte subpopulations involved in B cell activation . Immunology 1979;39:391-397. 9. Schröder JO, Euler HH, Löffler H: Synchronization of plasmapheresis and pulse cyclophosphamide in severe systemic lupus erythematosus . Ann Intern Med 1987;107:344-346.Crossref 10. Euler HH, Schroeder JO, Gutschmidt HJ, et al: The antibody rebound phenomenon as a rationale for synchronizing plasmapheresis with pulse cytotoxic drugs , in Oda T, Shiokawa Y, Inoue N (eds): Proceedings of the First International Congress of the World Apheresis Association: Therapeutic Plasmapheresis . Cleveland, International Society for Artificial Organs Press, 1987, pp 200-207.

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1988

References