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Plasmapheresis for treatment of pulmonary alveolar proteinosis

¹ Institute for Respiratory Disease, ² First Intensive Care Unit, and ³ Service of Immunohaematology and Transfusion Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy, and ⁴ Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

CORRESPONDENCE: M. Luisetti, Clinica Malattie Apparato Respiratorio, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Piazza Golgi 16, 27100 Pavia, Italy. Fax: 39 382422267. E-mail: m.luisetti{at}smatteo.pv.it

Keywords: Autoantibodies, granulocyte-macrophage colony-stimulating factor, surfactant, whole lung lavage

Received: June 28, 2008
Accepted October 2, 2008

Whole lung lavage (WLL) is currently the standard therapy for pulmonary alveolar proteinosis (PAP). Nevertheless, some PAP patients respond poorly to WLL or require it frequently. The present paper reports a patient with autoimmune PAP with persistent disease despite three WLL treatments over 10 months.

Plasmapheresis with ten 1.5-L plasma exchanges was performed, which lowered the serum granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibody level from 250 µg·mL^–1 to 156 µg·mL^–1 but did not improve respiratory impairment. Further WLL therapy was required and transiently effective. Serum GM-CSF autoantibody levels declined progressively, reaching a value of 56 µg·mL^–1 80 weeks after completion of plasmapheresis. However, this decrease was not accompanied by clinical improvement and the patient required additional WLL therapy.

The results confirm that minor reductions in serum granulocyte-macrophage colony-stimulating factor autoantibody levels from plasmapheresis are not reflected in clinical improvement in the severity of lung disease in pulmonary alveolar proteinosis.