Indications for Future Studies on the Treatment of Pemphigus With Plasmapheresis

To the Editor.—  Guillaume et al¹ reported on a controlled study of the use of plasmapheresis in 40 cases of pemphigus. Both the control and the experimental groups received upward of 0.5 mg/kg/day of prednisolone together with cyclophosphamide. While a few patients received up to 2 mg/kg/day, most were given about 30 mg/d. The 18 patients with pemphigus who were given plasma exchange treatment had 60 mL/kg removed in 4 weeks, a total of 1.5 times their total plasma volume. The comparisons led Guillaume and coworkers to conclude that, under the conditions used, the plasmapheresis had no therapeutic effect and that, since four patients in their experimental group died of sepsis, the plasma exchange poses significant risks for the patients. We agree with the comments of Bystryn² that the indications for plasmapheresis are not as a primary mode of treatment of pemphigus as used by Guillaume et al,¹ but