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.

Selective myeloid leucocyte depletion was effective for remission induction and improving patients’ quality of life. Baseline demographics such as disease activity level, duration and corticosteroid dependency appear to predict response to GMA. Additionally, patients with a first UC episode who were drug naive responded well to GMA and achieved a favorable long-term disease course by avoiding pharmacologics from an early stage of their inflammatory bowel disease. These findings should help to end unnecessary use of medical resources by targeting GMA to patients who may respond well.

Yoko Yokoyama ¹, Kenji Watanabe ², Hiroaki Ito ³, Masakazu Nishishita ⁴, Koji Sawada ⁵, Yusuke Okuyama ⁶, Kazuichi Okazaki ⁷, Hisao Fujii ⁸, Hiroshi Nakase ⁹, Tsutomu Masuda ¹⁰, Ken Fukunaga ¹¹, Akira Andoh ¹², Shiro Nakamura ¹³ ,

Cytotherapy 2015 May;17(5):680-8. 

https://pubmed.ncbi.nlm.nih.gov/25804800/