[Indications of plasma extraction during the treatment of monoclonal gammopathies]

Data from the french national registry show that about 20% of plasma exchange are performed to alleviate clinical manifestations related to a monoclonal Ig. Plasma removal has to be only considered as a part of therapy, the disease being controlled by cytotoxic drugs. However, owing to its delayed effect plasma exchange are useful to preserve the functional or vital prognosis. Technical aspects such as plasma volume removed or frequency of procedures will be scheduled according to monoclonal Ig specification: repartition between intra and extravascularly pools-allotypes-efficiency of chemotherapy. Hyperviscosity syndrome, interferences with hemostasis and vascular manifestations of cryoglobulins are the main established indications. Renal insufficiency of myeloma, peripheral neuropathies and unusual clinical symptoms associated with monoclonal gammapathy of undetermined significance should also be considered as possible indications. In contrast regression of amyloidosis deposits has not been reported.