Granulocytapheresis in Paediatric IBD

Abstract

Introduction: Selective Leukocyte Adsorptive Apheresis has proved its efficacy in adult inflammatory bowel disease (IBD), mainly in steroid-dependant or steroid-refractory Ulcerative Colitis. Granulocyte-monocyte apheresis is carried out through a direct blood perfusion system with a 335 mL capacity column filled with 220 g of cellulose diacetate beads (Adacolumn, JIMRO, Takasaki, Japan) that selectively adsorb circulating granulocytes and monocytes/macrophages. Objective: We present our results of granulocytapheresis on safety, tolerability and efficacy in a group of paediatric IBD patients followed up for one year. Material and Methods: Steroid-refractory and steroid-dependent ulcerative colitis patients and Crohn's disease patients with steroid-dependence or unresponsive to conventional treatments, aged between 11 and 18 years, with a mild-moderate flare-up (as defined by the modified Truelove index for UC and PCDAI for CD), were eligible. Nine patients (6 boys, 3 girls) entered our study, 5 steroid-dependent UC patients and 4 CD patients without sustained remission with different treatments (enteral nutrition, steroids, immunomodulators, infliximab) Mean age at inclusion was 13 years, 9 months and mean disease duration prior to inclusion had been 29 months. Granulocytapheresis consisted on 5 one hour length Adacolum sessions, one per week, for 5 consecutive weeks. Patients were followed for 52 weeks. In each visit, clinical symptoms, inflammatory markers and activity scores were evaluated. Results: In the UC group, 3/5 patients were in remission after 5 sessions (week 6). These 3 patients could taper off their steroid daily dose after 2 or 3 sessions. All of them maintained remission after 52 weeks without steroids. Other treatments (5-ASA, AZA) could also be stopped. In the CD group, 2 patients achieved clinical remission after 5 sessions (week 6) and another one did it later on the follow-up (week 17). One of the patients with an early response and the one with the late response maintained remission at the end of the study. No important side-effects due to the granulocytapheresis were observed and the technique was well tolerated by all our patients. Conclusions: Granulocytapheresis has shown its efficacy in our paediatric IBD patients. This is a very promising therapy especially in the paediatric age because of its safety, its steroid-sparing effect and its good tolerance. Certain aspects of this technique have to be further evaluated as its use in earlier stages of the disease seems to be more effective.