Plasma exchange combined with cytotoxic drugs and lymphocytapheresis for myasthenia gravis.

20 patients with myasthenia gravis (MG), refractory to anticholinesterase and steroid therapy, underwent plasma exchange therapy combined with immunosuppressive drugs and lymphocytapheresis. In all these patients an apparent clinical improvement was obtained since their first exchange session. During a follow-up of 8-18.5 months, a long-lasting benefit was achieved in 16 patients even though 6 of these had a single recurrence shortly after their first apheretic cycle. 3 patients who achieved substantial improvement of their symptoms during plasmapheresis showed recurrence of weakness after each apheretic course was stopped. However, their clinical response to therapy tended to improve with the following courses, which would be consistent with the effects of immunosuppression. This study strongly suggests that plasma exchange combined with immunosuppressive drugs and lymphocytapheresis can bring about dramatic and sustained improvement of MG and may alter its natural history.