Whole blood exchange-lymphoplasmapheresis combined transfusion as an immunotherapy in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) remains a therapeutic challenge. This study aims to evaluate the efficacy and safety of whole blood exchange-lymphoplasmapheresis combined transfusion (WLCT) in SLE. This retrospective study evaluated the clinical and immunological impact of WLCT in 84 patients with refractory SLE, compared to 61 controls receiving conventional therapy (CT). WLCT significantly attenuated disease activity, evidenced by reductions in Systemic Lupus Erythematosus Disease Activity Index scores, serum creatinine, uric acid, proteinuria, and glucocorticoid dependence. WLCT restored hemoglobin levels in autoimmune hemolytic anemia and suppressed pathogenic immunoglobulins (IgG, IgA, IgM). Flow cytometry showed expanded regulatory T cells and reduced Th17 frequencies, along with decreased IL-17A and TNF-α and increased TGF-β. Longitudinal follow-up demonstrated sustained benefits, including reduced proteinuria and neutrophil-driven inflammation at 12 months. These findings suggest that WLCT may offer therapeutic potential in controlling disease flares and mitigating organ damage in refractory SLE.