Hyperviscosity in Multiple Myeloma: The Case for TPE
When abnormal proteins build up in the blood, they can increase plasma viscosity and interfere with normal circulation. This condition, known as hyperviscosity syndrome (HVS), is most commonly associated with Waldenström macroglobulinemia, but it can also occur in multiple myeloma (MM).
At Renew TPE, we believe understanding when therapeutic plasma exchange (TPE) may be appropriate is an important part of providing timely care for patients with symptomatic hyperviscosity.
What Causes Hyperviscosity?
In Waldenström macroglobulinemia, excess IgM is typically responsible for increased blood viscosity. In multiple myeloma, high levels of monoclonal immunoglobulins—particularly IgA and IgG3—can contribute.
Symptoms can include:
Headache or dizziness
Blurred or impaired vision
Confusion or other neurologic changes
Fatigue or weakness
Abnormal bleeding
Shortness of breath
Severe hyperviscosity can become a medical emergency and requires prompt evaluation and treatment.
Where Does TPE Fit In?
Therapeutic plasma exchange removes plasma containing excess monoclonal proteins and replaces it with appropriate replacement fluid. This can rapidly reduce the circulating protein burden and serum viscosity.
Importantly, TPE does not treat the underlying malignancy. Instead, it addresses the immediate effects of excessive circulating proteins while disease-directed therapies work to control the source.
In this setting, TPE can serve as a rapid bridge to definitive treatment.
What Do the Guidelines Say?
The American Society for Apheresis (ASFA) classifies TPE for symptomatic hyperviscosity associated with hypergammaglobulinemia as a Category I, Grade 1B indication.
Category I indicates that apheresis is considered an accepted first-line treatment. For patients with significant symptoms, this supports TPE as an important part of the initial treatment strategy.
Don't Overlook Hyperviscosity in Multiple Myeloma
Hyperviscosity is less common in multiple myeloma than in Waldenström macroglobulinemia, but it can still have serious consequences.
For physicians, the takeaway is simple: when a patient with a monoclonal gammopathy develops symptoms consistent with hyperviscosity, consider the need for rapid intervention.
TPE can quickly reduce circulating monoclonal proteins and viscosity while treatment for the underlying disease is initiated.
At Renew TPE, we work with healthcare providers to help patients access therapeutic plasma exchange when clinically appropriate, with an emphasis on communication and coordinated care.
Need TPE Support?
Have a patient who may benefit from therapeutic plasma exchange? Contact Renew TPE to discuss TPE options and how we can support your patient and care team.