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Therapy of coagulation factor VIII autoantibodies with long-term extracorporeal protein A adsorption and
B M Taleghani1, R Grossmann, F Keller
1Department of Transfusion Medicine and Immunohematology, University of Wuerzburg, Germany.
Unlabelled:
Acquired factor VIII (FVIII) inhibitors in non-haemophiliacs may pose serious treatment problems.
Materials And Methods:
For IgG-adsorptions we utilized an automated plasma separation device and a plasma flow monitor.
Case Reports:
A 63-year old woman showed life-threatening bleeding because of an inhibitor. After stabilization by porcine FVIII three cycles of a modified Malmoe treatment protocol were applied, followed by long-term cyclophosphamide p.o. and weekly IgG-adsorptions. Within twelve months the patient exhibited a complete remission. A 54-year old man presented a comparable history. Because of a good response after the first cycle he was subsequently switched to the long-term therapy. Up to now (> 7 months) FVIII activities and inhibitor titers remained stable (10-20% rsp. < 3 BU/ml). In both cases no FVIII substitution therapy was necessary.
Conclusions:
A modified Malmoe protocol combined with long-term cyclophosphamide p.o. and weekly IgG-adsorptions seems to be an efficient, safe and cost-effective regimen for non-haemophiliacs with FVIII inhibitors.