Prevention and treatment of hyperviscosity syndrome

The clinical manifestations of hyperviscosity syndrome respond, at least transiently, to plasma exchange (PE). Once control of symptoms has been achieved, however, PE must be repeated since its effects are temporary [1].PE is therefore indicated whenever benefit might be expected from an acute removal of paraprotein [2–4]. It can be performed either as a symptomatic therapy for the immediate control of symptoms due to circulating paraprotein, during the period of chemotherapy induction, or as a maintenance therapy for those patients where it may be impossible to control paraprotein levels with chemotherapy alone: it may, in these cases, offer the patient a reasonable quality of life for a prolonged period [5]. Although the optimal balance between PE and cytostatics need is not known, long-term PE may have a sparing effect on chemotherapy [6,7].For the last 5 years we have treated hyperviscosity syndromes of various degrees with one or more intensive courses of PE, associated whenever possible with chemotherapy. In a few instances, a chronic PE treatment has been undertaken in selected cases of Waldenstrom macro- globulinemia. We have therefore performed a retrospective analysis of 29 treated patients, separated according to immunoglobulin class paraprotein, in order to evaluate PE need and its possible effect in the acute (or chronic) management of hyperviscosity syndrome.