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Immune tolerance induction in haemophiliacs with inhibitor to FVIII: high‐ or low‐dose programme
Author(s) -
KUCHARSKI W.,
SCHARF R.,
NOWAK T.
Publication year - 1996
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.1996.tb00141.x
Subject(s) - medicine , plasmapheresis , regimen , bolus (digestion) , extracorporeal , gastroenterology , antibody , continuous infusion , cyclophosphamide , surgery , urology , chemotherapy , immunology
Summary. In 1993–94, 15 high responders were treated in our centre according to the Malmo protocol which was modified as follows: serial plasmapheresis was performed instead of extracorporeal adsorbtion to protein A for reducing inhibitor levels and, after the bolus dose to neutralize the inhibitor, factor VIII concentrate was administered by a continuous infusion. Thus, this regimen included continuous infusion of factor VIII(FVIII) for 1–4 weeks, iv cyclophosphamide for 2 days and orally for 8–10 days, and intravenous immunoglobulin (IVIG) from the fourth day for 5 days. All patients had been qualified for the treatment when the antibody level was < 15 BU mL −1 . Tolerance was induced in 10 patients (66.6% very good and good results). The treatment failed in five cases in which, due to a high inhibitor level, it was not possible to maintain a measurable factor VIII:C concentration throughout the whole period of infusion. We compared these results with results of our low‐dose regimen: 25 IU FVIII kg −1 b.w. twice a week (1985–89, 11 high responders). The modified Malmo Protocol is much shorter than the low‐dose programme and this is a method of first choice in patients undergoing surgery in the near future.