Safety and efficacy of therapeutic plasma exchange in pediatric neuro-immunological diseases

Purpose: Therapeutic plasma exchange (TPE) is the treatment of choice in various neuro-immunological disorders in pediatric populations. This study assesses the safety and efficacy of TPE in this demographic.

Materials and methods: A single-center, retrospective cohort study involving pediatric patients who experienced neuro-immunological events and underwent TPE procedures at a tertiary referral center was conducted.

Results: The study included 81 patients (Guillain-Barre: 65, polyneuropathies: 5, myasthenia gravis: 8, multiple sclerosis: 3), undergoing collectively 360 TPE procedures. Fresh frozen plasma (FFP) was used in 76.1% of the TPE procedures. Adverse events (AEs) occurred in 50% of TPEs using FFP compared to 39.5% without. For procedures with at least two AEs, the rates were 24.5% with FFP vs 8.1% without. Incidence of allergic AEs was significantly higher in the FFP group (94.2% of TPE with at least one AE) compared to those without FFP (47.2%). Serious AE accounted for 1.2% of TPE procedures and 2.5% of patients. Effectiveness evaluations using a scale developed for this study and the Hughes Functional Grading Scale showed no significant clinical pre-treatment differences. After completing the treatment, children in the polyneuropathies group had the most severe clinical condition, and the largest relative improvement in clinical status was in the myasthenia gravis group.

Conclusions: TPE conducted by filtration is an effective and safe therapy for pediatric neuro-immunological diseases, with benefits outweighing the risks of complications. The use of FFP in therapy increases the probability of AE by 27%, and significantly raises the risk of allergic and multiple AEs.