Evaluation of Clinical Response according to Category and Level of Evidence for Therapeutic Plasma Exchange Indications: A Single-Center Experience

Abstract

Objective: The present study investigates the indications of patients who underwent therapeutic plasma exchange (TPE) based on the category and level of evidence outlined in the 2023 guidelines of the American Society for Apheresis (ASFA) and evaluates their treatment responses. Methodology: This retrospective study, the records of patients who underwent TPE at Van Yuzuncu Y & imath;l University Medical Faculty Hospital between January 2020 to December 2024 were reviewed, including their demographic characteristics, indications, plasmapheresis procedure data and complications. The indications were classified according to the categories, levels of evidence and treatment responses laid out in the ASFA 2023 guidelines. Results: A total of 234 adult patients were included in the study, of whom 56.4% were female. Hematological (41.9%) and neurological (38.5%) disorders accounted for the majority of the conditions treated with TPE. Of the total, 53% of the patients were classified as Category-I, while the total proportion of patients with Grade-IA, IB and IC evidence levels was 64.5%. The complete response rate was 35.5% in Category-I patients, the partial response rate was 48.6% in Category-II patients and the no response rate was 50% in Category-III patients. Patients with hematological and neurological disorders recorded high clinical response rates, while rarer conditions showed low clinical response rates. A significant relationship was found between category and level of evidence and clinical response (p<0.05). Conclusion: The clinical efficacy of TPE is significantly associated with the ASFA category and the level of evidence of the indications. The findings of the present study highlight the need to refer to evidence-based guidelines when planning TPE procedures.