Due to inadequate scientific evidence there are almost no established guidelines for the application of immune apheresis therapy in a specific disease condition. Relatively high costs and the requirement for specially trained staff and special technical equipment are the major reasons that apheresis therapy usually is not considered until life threatening conditions or end-stage disease have developed. In this complex situation, standardization of treatment and scientific evaluation is extremely difficult to manage. The preparation and conduct of well-designed randomized controlled trials evaluating the clinical effectiveness of immune apheresis therefore requires a close interdisciplinary collaboration of clinicians, researchers and industry. On this background, this review describes the current status and future trends of selective immune apheresis therapy in autoimmune diseases and immune-mediated clinical conditions in which antibodies antagonize special treatment options such as transplantation or coagulation factor substitution. In order to transfer persuasive clinical experience of apheresis experts into scientific evidence and general acceptance of this treatment modality, a more sophisticated patient selection and a harmonization of study protocols on an international perspective, together with prospective data collection by national and international registries, are the main future tasks of the apheresis community. (C) 2008 S. Karger GmbH, Freiburg i.Br.
