Centrifugal Plasma Exchange Versus Double-Filtration Plasmapheresis in Chronic CIDP: A Randomized Crossover Study Comparing Clinical Outcomes, Biological Effects, Procedure Times, and Costs—The Lymphoapheresis Study

Direct comparisons between centrifugal therapeutic plasma exchange (cTPE) and double-filtration plasmapheresis (DFPP) remain scarce. We compared cTPE and DFPP in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), regarding clinical outcomes, biological effects, tolerability, session times and hospital costs. Lymphoapheresis was a prospective, single-center, randomized, crossover ancillary study. At study entry, 5 patients with idiopathic CIDP on long-term therapeutic plasmapheresis were randomized to start with either cTPE or DFPP, then undergo 6 alternating sessions, for 30 sessions (15 cTPE, 15 DFPP) in all. Two patients had central venous access (CVA), and 3 had peripheral (PVA). Target treated plasma volume was identical for all patients. Clinical outcomes, intraprocedural tolerance, session-related biological changes, total session times, and procedure-related costs were compared using within-patient analyses and mixed-effects models. All 5 patients were men, median age 62 [56-68] years. The median treated plasma volume was similar for cTPE and DFPP sessions (4500 mL [4400-5000]). No difference was observed between modalities regarding short-term clinical outcomes or adverse events. Total session time differed insignificantly between modalities, but was longer with PVA than with CVA (201 [189-209] vs. 177 [163-192] minutes; p = 0.01). Compared with DFPP, cTPE induced greater per-session reductions in platelets, fibrinogen, prothrombin time, and IgG but not in IgM or Hb. Albumin use was markedly higher with cTPE than with DFPP (180 g vs. 20 g per session). By contrast, weight gain was greater with DFPP than with cTPE (1.0 [0.5-1.5] vs. 0.4 [0.0-0.5] kg; p = 0.04). Estimated hospital costs per session were higher with DFPP than with cTPE using HSA rather than FFP as fluid replacement, based on French blood product costs. The cost of DFPP is mainly due to material and platform costs and cTPE to blood products and staff requirements. In chronically treated CIDP patients, cTPE and DFPP showed similar short-term clinical efficacy and safety. Total session time depended on vascular access rather than the plasmapheresis modality. The cost of DFPP is mainly due to material and platform costs and cTPE to blood products and staff requirements.