Leukocytapheresis in inclusion body myositis


  • Peter C. Dau

    1. Division Allergy/Immunology, Department of Medicine, Evanston Hospital, Evanston, Illinois, and Department of Neurology, Northwestern University Medical School, Chicago
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A patient with inclusion body myositis was treated with a course of 22 leukocytaphereses combined with prednisone and azathioprine therapy. He improved clinically during an induction phase of frequent cytapheresis, which reduced the circulating levels of T lymphocytes and monocytes and decreased the ratio of the T4+ to T8+ lymphocyte subsets. During subsequent maintenance cytapheresis there was partial recovery of the T4+ population without recovery of T8+ lymphocytes, and the patient lost most of his clinical improvement. In contrast to T lymphocytes and monocytes, there was no persistent reduction in circulating Blymphocyte levels during the course of therapy. T8+ lymphocyte populations may regenerate more slowly than T4+ lymphocytes following depletion with leukocyatpheresis combined with prednisone and azathioprine therapy. A loss of of T8+ suppressor relative to T4+ helper-cell function could lead to an intensification of autoimmune conditions.