Plasmapheresis and Pulse Cyclophosphamide Therapy in Pemphigus Vulgaris: A Novelty or a Reappraisal?

To the Editor.—  I have read with interest the article published in the September 1987 issue of the Archives dealing with long-lasting and complete remission in a patient with refractory pemphigus vulgaris using an experimental treatment protocol based on synchronization of plasmapheresis with subsequent pulse cyclophosphamide therapy.¹ Plasmapheresis was applied both as a means of rapid elimination of circulating intercellular antibodies (abs) and also as a means for rebound stimulation of the ab-producing cells (feedback cycle between circulating abs and their production). In that way, the subsequent high-dose cyclophosphamide treatment, by exerting its cytotoxic effect during the period of assumed maximum proliferation and, thus, vulnerability of abproducing cell clones, could act optimally. In the "Comment" section of their article, the authors have pointed out that two "new" elements characterized the therapeutic approach in the case reported: the high dose of cyclophosphamide (total dose of the cyclophosphamide pulse, 1500 mg)