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.
The Relevance of the Processed Blood Volume per Granulocyte and Monocyte Apheresis Session to its Clinical Efficacy in Patients with Ulcerative Colitis
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.
The Italian registry of therapeutic apheresis: Granulocyte-monocyte apheresis in the treatment of inflammatory bowel disease. A multicentric study.
Stefano Passalacqua 1, Pietro Manuel Ferraro, Giampaolo Bresci, Valeria D’Ovidio, Marco Astegiano, Mariabeatrice Principi, Roberto Testa, Renata D’Incà, Daniela Valpiani, Alessandro Armuzzi, Renato Sablich, Flaminia Cavallaro, Francesco Costa, Vincenza Di Leo, Elisabetta Colombo, Alessia Santini, Annalisa Aratari, Pierenrico Lecis, Valeria Saladino, Gabriele Riegler, Marino Marco, Francesca Calella, Chiara Ricci, Maria Luisa Guidi, Giuseppe Repaci, Michele Silla, J Clin Apher. 2011 Dec;26(6):332-7.
Leukocytes are thought to play an important role in the pathogenesis of inflammatory bowel diseases; granulocyte-monocyte adsorptive (GMA) apheresis, an extracorporeal technique aimed at removing activated circulating leukocytes from the blood, may represent a safe and effective therapeutic tool in these patients. The Italian Registry of Therapeutic Apheresis performed an observational, multicentric study involving 24 Gastroenterology Units. In this study, laboratory data and clinical outcomes of 230 patients (148 males, mean age 43.5 years) affected with ulcerative colitis (UC, n = 194) or Crohn’s disease (CD, n = 36) who underwent one or more cycles of GMA were analyzed. Each cycle consisted of five GMA treatments. The patients were followed up for a mean of 8.7 (min. 3 to max. 12) months. At 3 months, positive outcome was achieved in 77.7% of UC patients (72.0% remission, 5.7% clinical response) and 61.3% of CD patients (54.8% remission, 6.5% clinical response). The cumulative proportion of positive outcome at 12 months was 87.1% for UC patients (83.7% remission, 3.4% clinical response) and 77.4% for CD patients (74.2% remission, 3.2% clinical response). No single clinical or laboratory parameter among those analyzed (age, sex, disease characteristics, history of smoking, medication history, baseline values of clinical activity index (CAI)/Crohn’s disease activity index (CDAI), hemoglobin, white blood cells count, and erythrocyte sedimentation rate) was independently associated with clinical outcome. The procedure was well tolerated with no significant adverse effects registered.
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