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

Abstract

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 (3000mg/day) and occasional prednisolone (≤20mg/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.