Tina S. Ipe, Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, ArkansasDepartment of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
Jay S. Raval, Department of Pathology, University of New Mexico, Albuquerque, New Mexico Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
Leonor P. Fernando, Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California
Amit Gokhale, Department of Pathology, Stony Brook University, Stony Brook, New York
Cyril Jacquot, Department of Laboratory Medicine and Hematology, Children's National Health System, Washington, District of Columbia
Andrew D. Johnson, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
Haewon C. Kim, Department of Pediatrics and Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Grace F. Monis, Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California
Yunchun D. Mo, Department of Laboratory Medicine and Hematology, Children's National Health System, Washington, District of Columbia
Shanna M. Morgan, American Red Cross, Minneapolis, Minnesota
Monica B. Pagano, Department of Laboratory Medicine, University of Washington, Seattle, Washington
Huy P. Pham, Department of Pathology, University of Southern California, Los Angeles, California
Kimberly Sanford, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
Amy E. Schmidt, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
Joseph Schwartz, Department of Pathology and Cell Biology, Columbia University, New York, New York
Jennifer Webb, Department of Laboratory Medicine and Hematology, Children's National Health System, Washington, District of Columbia
Jeffrey L. Winters, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
Yanyun Wu, Bloodworks Northwest, Seattle, Washington
Chisa Yamada, Department of Pathology, University of Michigan, Ann Arbor, Michigan
Edward C C Wong, Department of Coagulation, Quest Diagnostics Nichols Institute, Chantilly, VirginiaDepartment of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences and Children's National Hospital, Washington, District of Columbia
Amy Waldman, Department of Pediatrics and Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Document Type

Article

Publication Date

1-1-2020

Abstract

IMPORTANCE: Neuromyelitis optica/neuromyelitis optica spectrum disorder patients' response to therapeutic plasma exchange (TPE) is currently incompletely characterized.

OBJECTIVE: Our study aims to understand the clinical status improvement of neuromyelitis optica/neuromyelitis optica spectrum disorder patients treated with TPE.

DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter retrospective study conducted between 1 January 2003 and 31 July 2017 at 13 US hospitals performing apheresis procedures. Subjects studied were diagnosed with neuromyelitis optica/neuromyelitis optica spectrum disorder who received TPE during presentation with acute disease.

MAIN OUTCOMES AND MEASURES: The primary outcome was clinical status improvement in patients treated with TPE. Secondary measures were procedural and patient characteristics associated with response to treatment.

RESULTS: We evaluated 114 patients from 13 institutions. There was a female predilection. The largest ethnic group affected was non-Hispanic Caucasian. The average age of diagnosis was 43.1 years. The average time to diagnosis was 3.1 years. On average, five procedures were performed during each treatment series. The most commonly performed plasma volume exchange was 1.0 to 1.25 using 5% albumin as replacement fluid. Most patients (52%) did not require an additional course of TPE and noted "mild" to "moderate" clinical status improvement. Maximal symptom improvement appeared by the fourth or fifth TPE treatment.

CONCLUSION AND RELEVANCE: TPE improved the clinical status of patients. Adults responded more favorably than children. Procedural characteristics, including number of TPEs, plasma volume exchanged, and replacement fluid used, were similar between institutions. TPE was well-tolerated and had a low severe adverse event profile.

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