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November 1988

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

Author Affiliations

Second Department of Internal Medicine; Department of Dermatology Christian Albrecht University Metzstrasse, D-2300 Kiel, West Germany

Arch Dermatol. 1988;124(11):1717-1718. doi:10.1001/archderm.1988.01670110073019

In Reply.—  The rationale behind the "synchronization" concept of plasmapheresis with subsequent pulse cyclophosphamide therapy is to utilize the increased vulnerability of pathogenic B cells by applying high-dose cytotoxic drugs shortly after antibody depletion during the period of maximum antibody rebound, ie, during the period of maximum depletion-induced B-cell proliferation and vulnerability. This basic concept was applied experimentally as early as 1971.1 It was first applied clinically in myasthenia gravis in 1980,2 in systemic lupus erythematosus in 1981,3 and in Goodpasture's syndrome in 1982.4 It was suggested for severe pemphigus5 in 1983, and it was first applied clinically in pemphigus vulgaris in one of seven briefly reported cases in a 1984 article by Ruocco and coworkers.6 We regret that none of us had seen that article.However, though the basic rationale is the same as in our report,7 there are some major differences concerning the strictness

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