Scientific corner

Adalimumab therapy following granulocyte and monocyte adsorptive apheresis in a patient with Crohn’s disease accompanied by chronic myeloid leukemia

Tsutomu Mizoshita 1Satoshi Tanida 2Shigeru Kusumoto 3Keiji Ozeki 2Hironobu Tsukamoto 2Masahide Ebi 2Yoshinori Mori 2Hiromi Kataoka 2Takeshi Kamiya 2Takashi Joh 2,Clin J Gastroenterol. 2012 Aug;5(4):302-6.

A 52-year-old woman was diagnosed with Crohn’s disease (CD) of the large intestine in May 2001. Her disease was accompanied by the development of chronic myelogenous leukemia (CML) in December 2003. Remission of her CML has been maintained up to the present with tyrosine kinase inhibitors. Clinical and endoscopic remission of the patient’s CD was maintained with salazosulfapyridine (3000 mg/day) and occasional prednisolone (≤20 mg/day) from 2001 to 2010. However, in December 2010 the patient complained of abdominal pain and diarrhea more than 10 times a day. Endoscopy showed serpiginous (snake-like) ulcers in the transverse colon and aphthous ulcers in the sigmoid colon. Intensive granulocyte and monocyte adsorptive apheresis (GMA) (two sessions per week, total of ten sessions) was performed, and the CD activity index (CDAI) decreased from 259 to 175. Six adalimumab injections were administered to improve the remaining inflammatory mucosa. Two months after induction therapy with adalimumab, the CDAI decreased from 175 to 107 without side effects. Endoscopy revealed mucosal healing of the colonic inflammatory lesions. We experienced a case of a patient with CD accompanied by CML. We successfully treated the patient by a combination of intensive GMA and adalimumab

Scientific corner

Combination Therapy with Intensive Granulocyte and Monocyte Adsorptive Apheresis plus Adalimumab: Therapeutic Outcomes in 5 Cases with Refractory Crohn’s Disease

Keiji Ozeki 1Satoshi TanidaTsutomu MizoshitaHironobu TsukamotoMasahide EbiYoshinori MoriHiromi KataokaTakeshi KamiyaTakashi Joh, Case Rep Gastroenterol. 2012 Sep;6(3):765-71.

Adalimumab (ADA) is applied to induce remission in patients with Crohn’s disease (CD) naïve to chimeric anti-tumor necrosis factor-α (anti-TNF-α), infliximab or patients with loss of response to scheduled maintenance infliximab. Adsorptive granulocyte and monocyte apheresis (GMA) depletes elevated/activated myeloid lineage leucocytes as sources of inflammatory cytokines and has been used to treat patients with CD. This study was to investigate the efficacy of intensive GMA in combination with ADA as remission induction therapy in cases of CD refractory to medications including anti-TNF-α therapies. Between December 2010 and February 2012, 5 consecutive cases with refractory CD were treated with intensive GMA (2 sessions per week) plus ADA to induce remission. CD activity index (CDAI), C-reactive protein (CRP), and endoscopic findings based on the simple endoscopic score for CD (SES-CD) at baseline and 10 weeks post 5 ADA injections were applied to determine treatment efficacy outcomes. At week 10 post ADA treatment, clinical remission together with normal CRP levels were achieved in all 5 cases, while SES-CD scores reflected marked improvement in 3 cases and partial improvement in 2 cases who had extensive deep longitudinal CD lesions. The CDAI and CRP values at baseline were 324 ± 118 and 4.9 ± 3.3 mg/dl, respectively. The corresponding values after treatment were 100 ± 28 (p = 0.024) and 0.2 ± 0.2 mg/dl (p = 0.038). In these 5 cases with medication-refractory CD, combination therapy with intensive GMA followed by 5 ADA shots appeared to be an effective and safe intervention for inducing clinical remission.

Scientific corner

The Italian registry of therapeutic apheresis: Granulocyte-monocyte apheresis in the treatment of inflammatory bowel disease. A multicentric study.

Stefano Passalacqua 1Pietro Manuel FerraroGiampaolo BresciValeria D’OvidioMarco AstegianoMariabeatrice PrincipiRoberto TestaRenata D’IncàDaniela ValpianiAlessandro ArmuzziRenato SablichFlaminia CavallaroFrancesco CostaVincenza Di LeoElisabetta ColomboAlessia SantiniAnnalisa AratariPierenrico LecisValeria SaladinoGabriele RieglerMarino MarcoFrancesca CalellaChiara RicciMaria Luisa GuidiGiuseppe RepaciMichele 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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