Yoshifumi Hamasaki ¹, Ryo Matsuura ², Takahide Shinagawa ³, Soichiro Ishihara ³, Sozaburo Ihara ⁴, Mitsuhiro Fujishiro ⁴, Kent Doi ⁵, Masaomi Nangaku ^1 2

J Clin Med Res. 2024 Dec;16(12):625-634. doi: 10.14740/jocmr6071. Epub 2024 Dec 20.

Background: Granulocyte and monocyte adsorption apheresis (GMA) is a therapeutic option for remission induction in the active ulcerative colitis (UC) patients. Effects of high processed blood volume of GMA as remission induction therapy on the long-term prognosis of UC patients have remained unclear. For this study, we investigated the relation between re-exacerbation of UC and the processed blood volume of GMA performed as induction therapy.

Methods: Data from UC patients treated using a total of 10 GMA sessions as remission induction therapy during 2012 – 2022 were retrospectively collected and analyzed. The relation between the GMA dose, processed blood volume of GMA divided by body weight, and UC re-exacerbation requiring inpatient treatment within 1 year was evaluated.

Results: This study examined data of 72 active UC patients, with median age of 44.4 years (65% male) and median GMA dose of 34.2 mL/kg/session. Kaplan-Meier analysis showed the 1-year exacerbation-free rate was significantly higher in the higher GMA dose group than in the lower GMA dose group (P = 0.008). Cox proportional hazards regression analyses revealed a higher GMA dose as inversely associated with the re-exacerbation of UC within 1 year (hazard ratio: 0.36, 95% confidence interval: 0.17 – 0.78). Extended treatment time of GMA session beyond 60 min contributed to achieving the higher GMA dose and did not increase unexpected treatment termination because of clotting.

Conclusion: Greater processed blood volume of GMA per patient body weight may be associated with a lower 1-year exacerbation rate in UC patients.

Risa Kikuyama ¹, Ken Fukunaga, Mikio Kawai, Yoko Yokoyama, Koji Kamikozuru, Nobuyuki Hida, Yoshio Ohda, Naohisa Takeda, Koji Yoshida, Masaki Iimuro, Kyoichi Kato, Tomoaki Kono, Koji Nogami, Kazuko Nagase, Shiro Nakamura, Yoshiyuki Takei, Hiroto Miwa, Takayuki Matsumoto, Ther Apher Dial. 2011 Aug;15(4):360-6.

Granulocyte/monocyte adsorption (GMA) has been introduced as an adjunct intervention for active ulcerative colitis (UC) patients. The processed blood volume (PV) per GMA session is an important factor for its efficacy because depletion of elevated/activated myeloid leukocytes is its main action. Hitherto, this aspect of GMA has been largely ignored. Thirty-three patients were enrolled for remission induction therapy with five weekly GMA sessions at a standard PV of 1800 mL, regardless of patients’ bodyweight (BW). The patients were divided into three groups: high (H)BW (≥ 65 kg, n = 11), 50 kg ≤ medium (M)BW < 65 kg (n = 12), and low (L)BW (≤ 50 kg, n = 10). UC clinical activity index (CAI) was according to Lichtiger, and the clinical efficacies were evaluated at both one week post 3(rd) GMA (Week 4) and one week post 5(th) GMA (Week 6). The average BW was 70.9 ± 6.2 kg in HBW, 55.8 ± 4.5 kg in MBW, and 46.8 ± 1.2 kg in LBW, indicating the mean PV/BW in the three groups being 25.6 ± 2.12, 32.5 ± 2.50, and 38.7 ± 1.0 (mL/kg, P < 0.05), respectively. The LBW group consisted of female patients only. Significant improvements of CAI were seen before treatment at either Week 4 or Week 6 in all groups. A significantly higher remission rate was achieved in the LBW (80.0%) vs. MBW (33.3%) or HBW (27.3%) at Week 6 (P < 0.03). According to this GMA evaluation, the lower-limit of optimum PV/kg should be higher than 38.7 mL/kg for its potential clinical efficacy to be significantly greater than the routine GMA method. Additional BW-oriented GMA studies in larger and gender controlled cohorts of patients should strengthen our findings.

https://pubmed.ncbi.nlm.nih.gov/21884470/