Academic Journal
Centrifugation-based plasma exchange overcomes blood flow restriction to rescue hyperviscosity syndrome in IgM-κ multiple myeloma: a case report.
| Τίτλος: | Centrifugation-based plasma exchange overcomes blood flow restriction to rescue hyperviscosity syndrome in IgM-κ multiple myeloma: a case report. |
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| Συγγραφείς: | Osakabe H; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan. osakabe@kochi-u.ac.jp., Yamamoto S; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan., Shigehisa R; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan., Osakabe Y; Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Nankoku, Japan., Matsumoto T; Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Nankoku, Japan., Yoshimura R; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan., Fukata S; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan. jm-fukatas@kochi-u.ac.jp., Inoue K; Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan. |
| Πηγή: | Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs [J Artif Organs] 2026 Aug 01; Vol. 29 (3). Date of Electronic Publication: 2026 Aug 01. |
| Τύπος έκδοσης: | Journal Article; Case Reports |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Verlag Country of Publication: Japan NLM ID: 9815648 Publication Model: Electronic Cited Medium: Internet ISSN: 1619-0904 (Electronic) Linking ISSN: 14347229 NLM ISO Abbreviation: J Artif Organs Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Tokyo : Springer Verlag, c1998- |
| Ιατρικοί όροι (MeSH): | Multiple Myeloma*/therapy , Multiple Myeloma*/blood , Plasma Exchange*/methods , Blood Viscosity*, Immunoglobulin M/blood ; Immunoglobulin kappa-Chains/blood ; Humans ; Male ; Aged, 80 and over ; Centrifugation |
| Περίληψη: | When blood flow cannot be raised to the 150-200 mL/min threshold required for membrane-based therapeutic plasma exchange, centrifugation-based therapeutic plasma exchange represents the only mechanistically viable option-yet this specific clinical scenario has not been reported. We describe an 86-year-old man with IgM-κ multiple myeloma who developed hyperviscosity syndrome. Sequential membrane-based approaches failed owing to blood flow restriction: double-filtration plasmapheresis was discontinued when secondary membrane pressure reached 277 mmHg, and membrane-based therapeutic plasma exchange achieved only a 20.1% IgM level reduction at a subtherapeutic flow of 45-60 mL/min. Centrifugation-based therapeutic plasma exchange, operable at 10-150 mL/min, was performed in two sessions via bilateral peripheral antecubital venous access using fresh frozen plasma, achieving IgM level reductions of 67.3 and 66.2% with prompt symptomatic relief and no serious adverse events. Diagnosis of IgM-κ multiple myeloma was established by absence of the MyD88 L265P mutation and presence of t(11;14) on bone marrow cytogenetics. The patient was discharged on lenalidomide plus dexamethasone, with no hyperviscosity syndrome recurrence at follow-up. To our knowledge, this is the first reported case in which centrifugation-based therapeutic plasma exchange served as rescue therapy in a patient for whom blood flow restriction rendered membrane-based modalities non-functional-a clinical niche not addressed in prior comparative studies. (© 2026. The Author(s), under exclusive licence to the Japanese Society for Artificial Organs.) |
| Competing Interests: | Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: All procedures were conducted in accordance with the tenets of the 1964 Declaration of Helsinki and its later amendments. Formal ethics committee approval was waived by the Institutional Review Board of Kochi University Hospital (Kochi, Japan) for this single-patient case report. Informed consent: Written informed consent was obtained from the patient for the publication of de-identified clinical information and accompanying images included in this article. |
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| Contributed Indexing: | Keywords: Apheresis; Centrifugation; Hyperviscosity syndrome; Multiple myeloma; Therapeutic plasma exchange |
| Substance Nomenclature: | 0 (Immunoglobulin M) 0 (Immunoglobulin kappa-Chains) |
| Entry Date(s): | Date Created: 20260801 Date Completed: 20260801 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1007/s10047-026-01578-3 |
| PMID: | 42541591 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1619-0904 |
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| DOI: | 10.1007/s10047-026-01578-3 |