Rebound and overshoot after plasma exchange in humans

On the basis of animal experiments, some authors recommend a routine combination of therapeutic plasma exchange in patients with immunologically mediated disorders, such as autoimmune and immune complex diseases, with administration of cytotoxic drugs to prevent overshoot in plasma levels of pathogenic components after plasma exchange. We examined one healthy volunteer, seven patients with nonimmunologic diseases, and seven patients with immunologically mediated disorders (six with non-organ specific and one with organ-specific autoantibodies) to test whether plasma exchange is succeeded by an overshoot in levels of immunoglobulins, isohemagglutinins, autoantibodies, and antibodies after booster immunization with diphtheria and tetanus toxoid combined with poliomyelitis vaccine. Our data indicate that overshoot is not a generally occurring phenomenon in humans. We also confirmed the capability of corticosteroids, administered immediately after a period of plasma exchange, to reduce autoantibody levels. We found no arguments to support the suggestions in the literature that plasma exchange be combined with cytotoxic drugs in treatment of immunologically mediated diseases to prevent stimulation of potentially pathogenic components such as autoantibodies.