Non-pharmacological Management of Paraproteinemia

Paraproteins occasionally result in life-threatening hyperviscosity syndrome that causes harmful effects on various body tissues. These effects, despite therapy, can be irreversible. A clone-directed approach to paraproteinemia aims at quickly suppressing paraprotein production. Non-pharmacological therapies such as plasmapheresis eliminate paraproteins rapidly and may be used in the initial treatment phases alone or combined with clone-specific therapies to induce or maintain the therapeutic response. These therapies are typically employed as an emergency tool to reduce the paraproteins level temporarily until a reduction of synthesis is achieved by clone-directed therapy. Plasmapheresis is most commonly used for conditions such as cryoglobulinemia, multiple myeloma, and Waldenström’s macroglobulinemia. Other modalities that are currently under experimentation may prove to be successful. They may add new tools to our medical armamentarium. In this chapter, we discuss the new developments in the management of paraproteinemias by non-pharmacological methods.