What is the recommended duration of a session with Adacolumn®?

Dr. Iago Rodríguez Lago

If we are speaking about the time of each session, we should have our aim of sessions that last for 1 hour, and this means we are filtering around 1800 million liters of the patient’s volume. Well, this is the official recommendation and the current recommendations for the apheresis, but we have the experience that we can make longer sessions and this means that if we are applying the apheresis for a longer time, usually around 1 hour and a half or 90 minutes, we still can see that the block cells are still adhering to the column. So well, if this means that we are still applying some effect on the apheresis, we can expect a higher efficacy. So at least in our practice, we are applying longer sessions for 90 minutes. Therefore, our experience, I think it is good.

• Instructions for use of Adacolumn®.
• Cabriada, J.L., Rodríguez-Lago, I. Granulocitoaféresis en 2017. Puesta al día. Enfermedad Inflamatoria Intestinal 2017 (16) 2, 62-69
• Sakuraba A et al. An open-label prospective randomized multicenter study shows very rapid remission of ulcerative colitis by intensive granulocyte and monocyte adsorptive apheresis as compared with routine weekly treatment. Am J Gastroenterol. 2009 Dec;104(12):2990-5. 19724269.
• Kanke K Nakano M Hiraishi H Terano A. Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis. Dig. Liver Dis. 2004; 36(12):811-7.
• Yoshimura N et al. Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes. J Gastroenterol. 2012 Jan;47(1):49-55.
• Hanai H et al. Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study. Clin Gastroenterol Hepatol. 2003 Jan;1(1):28-35.
• Yoshino T et al. Efficacy and safety of granulocyte and monocyte adsorption apheresis for ulcerative colitis: a meta-analysis. Dig Liver Dis. 2014 Mar;46(3):219-26.
• PRODIGGEST CLINICAL PRACTICE PROTOCOLS: Rational use of granulocytopheresis in inflammatory bowel disease 2019.

Dr. Eugeni Domènech

The characteristics of each GMA session can vary mainly because of two main characteristics. The first one is the flow through the filter and the second one is the volume of the blood that is treated in each session. Initially, GMA sessions were of 1 hour of duration at a constant flow. However, treating the patients this way resulted in a different volume of blood was treated. In those patients with low weight, a higher proportion of blood volume was treated whereas in those patients with higher weight, the proportion of blood treated was lower. Now, most of the bloodline units and dialysis units in which patients are treated with GMA preestablish the volume of blood to be treated. And regarding this, the duration of the session will vary from 1 hour to 2 hours per session.

• Instrucciones de uso de Adacolumn®
• Yoshimura N et al. Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes. J Gastroenterol. 2012 Jan;47(1):49-55.
• Domènech, E., et al Use of granulocyte/monocytapheresis in ulcerative colitis: A practical review from a European perspective. World journal of gastroenterology, 2021 27(10), 908–918. 

Dr. Daniel Ginard

The duration has also changed. Initially a session lasted an hour, which was around 1,800 ml filtrated blood. But we have seen that this might not make much sense. Firstly, because people’s body volume is not the same. An 18-year-old who weighs 40 kg is not the same as a person who weighs 90 kg. So, we have been modifying it and it can be done by body mass index, or we can do it simply by trying to increase the filtered volume, because the percentage of filtered volume should be different depending on the patient’s weight. We have seen that the column lasts up to 3 hours with a high level of effectiveness. And with respect to the issue of the volume we can filter, to improve effectiveness, we are doing sessions of between 90 and 120 minutes. The most widely accepted regimen is 90 minutes.

• Yamamoto T et al. Safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis therapy for ulcerative colitis. World J Gastroenterol. 2006 Jan 28;12(4):520-5.
• Kanke K et al. Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis. Dig Liver Dis. 2004 Dec;36(12):811-7.
• Saniabadi AR et al. Adacolumn®, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes. Ther Apher Dial. 2003 Feb;7(1):48-59.
• Yoshimura N et al. Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes. J Gastroenterol. 2012 Jan;47(1):49-55.
• PRODIGGEST CLINICAL PRACTICE PROTOCOLS: Rational use of granulocytopheresis in inflammatory bowel disease 2019.

Dr. Francisco Fernández

Traditionally we have been using, in treatment with Adacolumn®, sessions of 60 minutes at 30 millilitres/minute, a total volume of 1,800 millilitres of blood filtered. However, it has been demonstrated in some studies that treatment over a longer period does not minimize the effectiveness of the filter. On the other hand, it has also been demonstrated that when the total flow volume is adapted to the patient’s weight, the results are optimized without any worsening or a higher number of side effects. So, our centre, for example, where we initially used a regimen of 60 minutes, 30 milliliters per minute, we now very often use 90 minutes at 30 milliliters per minute. In other words, the amount filtered has been increased from 1,800 to 2,700 ml. But there is also the option of adapting the volume filtered to the patient’s weight at a rate of 60 milliliters per kilogram of body weight and that adaption, not so much in ratio or speed of filtration, which would still be 30 milliliters per minute, that would be the standard regimen, and we would extend the total time to achieve this.

• Adacolumn@ instructions for use.
• Cabriada, J.L., Rodríguez-Lago, I. Granulocitoaféresis en 2017. Puesta al día. Enfermedad Inflamatoria Intestinal 2017 (16) 2, 62-69.
• Sakuraba A et al. An open-label prospective randomized multicenter study shows very rapid remission of ulcerative colitis by intensive granulocyte and monocyte adsorptive apheresis as compared with routine weekly treatment. Am J Gastroenterol. 2009 Dec;104(12):2990-5. 19724269.
• Kanke K Nakano M Hiraishi H Terano A. Clinical evaluation of granulocyte/monocyte apheresis therapy for active ulcerative colitis. Dig. Liver Dis. 2004; 36(12):811-7.
• Yoshimura N et al. Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes. J Gastroenterol. 2012 Jan;47(1):49-55.
• Hanai H et al. Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study. Clin Gastroenterol Hepatol. 2003 Jan;1(1):28-35.
• Yoshino T et al. Efficacy and safety of granulocyte and monocyte adsorption apheresis for ulcerative colitis: a meta-analysis. Dig Liver Dis. 2014 Mar;46(3):219-26.
• PRODIGGEST CLINICAL PRACTICE PROTOCOLS: Rational use of granulocytopheresis in inflammatory bowel disease 2019.