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Prominent plasmacytosis following intravenous immunoglobulin correlates with clinical improvement in Guillain-Barré syndrome.
PLoS ONE. 2008 May 7;3(5):e2109.
Mori I, Parizot C, Dorgham K, Demeret S, Amoura Z, Bolgert F, Gorochov G.
Institut National de la Santé et de la Recherche Médicale (INSERM) U543, Paris, France.
BACKGROUND:
High doses of pooled polyclonal IgG are commonly used to treat numerous
autoimmune diseases. Their mode of action nevertheless remains only
partially explained. At the same time, until now, no early biological
marker has been able to predict their efficacy. METHODOLOGY/PRINCIPAL
FINDINGS: In a first pilot retrospective analysis, we reviewed white
blood cell counts and blood smears in consecutive patients with
autoimmune disease (n = 202) and non-autoimmune disease (n = 104).
Autoimmune patients received either intravenous immunoglobulin (IVIg, n
= 103), plasma exchange (n = 78) or no specific treatment (n = 21).
We
then prospectively monitored consecutive autoimmune patients with IVIg
injection (n = 67), or without any specific treatment (n = 10) using
the same routine laboratory tests, as well as flow cytometry. Both
retrospective and prospective analyses identified large plasma-cell
mobilization exclusively in IVIg-treated autoimmune patients 7 days
after initiation of treatment. The majority of IVIg-mobilized plasma
cells were immature HLA-DR(high)/CD138(low)/CXCR4(low) plasma cells
expressing intracellular immunoglobulin G which were neither IVIg- nor
human IgG-specific. Importantly, we found a strong negative correlation
between the absolute number of IVIg-mobilized plasma cells and time to
improve neurological function in both retrospective and prospective
studies of Guillain-Barré syndrome (GBS), (r = -0.52, p = 0.0031, n =
30, r = -0.47, p = 0.0028, n = 40, respectively).
CONCLUSIONS/SIGNIFICANCE: IVIg promotes immature plasma-cell
mobilization in patients with GBS, chronic inflammatory demyelinating
polyneuropathy, myasthenia gravis and inflammatory myopathy. Prominent
day 7 plasma-cell mobilization is a favourable prognostic marker in
patients with GBS receiving IVIg treatment.
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