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[Evaluation of plasmapheresis in terminal stage patients with urogenital malignant tumors].

We performed plasmapheresis in 8 patients (6 males and 2 females) with urogenital malignant tumors to improve their clinical conditions. Four were with renal cancer, 2 prostatic cancer, 1 renal pelvic cancer and 1 embryonal cancer of the testis. All were in the terminal stage, being inoperable because of advanced stage or disseminated recurrence after previous surgical treatment. Chemotherapy, radiation therapy and/or immunotherapy were used in combination with plasmapheresis. Eleven cycles of plasmapheresis were performed in these 8 patients, i. e. , 8 cycles of single membrane filtration plasmapheresis (SFPP) in 6 patients, and 3 cycles of double membrane filtration plasmapheresis (DFPP) in 2 patiens. Heated human plsma protein fraction (HHPPF) or fresh frozen plasma (FFP) were used as substitution fluids. The volume of exchnaged sera on the occasion of each procedure was 2000 to 3000 ml. Plasmapheresis was performed 2 to 3 times a week and one cycle comprised 6 to 15 sessions. We estimated changes in level of consciousness, feeding, pain and performance status before, during and after each one cycle. Clinical improvement was found after 7 cycles of plasmapheresis in 6 patients. Improvement in consciousness level was observed in 4 patients, improvement in feeding in 2 patients. Better clinical improvements were achieved by SFPP using FFP than by SFPP using HHPPF or by DFPP. As side effects of plasmapheresis, macrohematuria and subcutaneous bleeding were observed in 2 cases when HHPPF was used. Hypotension and uriticaria were observed in a few cases during plasmapheresis. In addition, mild decline of hepatic function was observed in a few cases after treatment, but severe heptitis was not found in any case. It was suggested that SFPP using FFP was most effective in improving the general condition in patients with malignant tumors.