Kaplan, Gary · Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis · 2026 · DOI
This review examines whether immune system abnormalities in ME/CFS, long COVID, and related post-infectious conditions might respond to immune-modifying treatments such as plasma exchange and immunoglobulin therapy. The authors report that while some patients with specific immune markers showed improvements in observational studies, two large controlled trials (RituxME in ME/CFS and a TPE trial in long COVID) did not demonstrate benefit in unselected patient groups, suggesting that better ways to identify which patients might benefit are needed.
For ME/CFS patients and researchers, this review is relevant because it synthesises evidence on immune abnormalities observed across multiple post-infectious syndromes including ME/CFS, and critically evaluates whether immune-directed treatments—such as plasma exchange—might help. The finding that large trials in ME/CFS and long COVID failed in unselected populations underscores an important clinical lesson: future treatment research may need to identify and enrol only patients with specific immune biomarkers, rather than treating all patients with the diagnosis.
This narrative review does not establish causation between immune abnormalities and ME/CFS symptoms, does not prove that immune-modifying therapies treat ME/CFS, and does not provide guidance on which individual ME/CFS patients should receive plasma exchange or other immune therapies. The review's findings about long COVID, PTLDS, and PANS/PANDAS do not automatically apply to ME/CFS, as these are distinct diagnostic entities with overlapping but not identical phenotypes. Negative trials in unselected populations do not rule out efficacy in biomarker-positive subgroups, but neither do observational reports of improvement constitute evidence of treatment effectiveness.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Kaplan, Gary (2026). Therapeutic plasma exchange and immunomodulatory strategies in post-infectious syndromes: A review of immune dysregulation in PTLDS, long COVID, ME/CFS, and PANS/PANDAS.. Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. https://doi.org/10.1016/j.transci.2026.104482
BibTeX
@article{mecfsatlas-kaplan-2026-therapeutic-plasma,
author = {Kaplan, Gary},
title = {Therapeutic plasma exchange and immunomodulatory strategies in post-infectious syndromes: A review of immune dysregulation in PTLDS, long COVID, ME/CFS, and PANS/PANDAS.},
journal = {Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis},
year = {2026},
doi = {10.1016/j.transci.2026.104482},
note = {PubMed: 42391726},
url = {https://www.mecfsatlas.com/evidence/kaplan-2026-therapeutic-plasma},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-07-08. https://www.mecfsatlas.com/evidence/kaplan-2026-therapeutic-plasma
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