P0680 LEUKOCITE ADSORPTIVE APHERESIS IN PAEDIATRIC INFLAMMATORY BOWEL DISEASE: SAFETY, TOLERANCE AND PRELIMINARY DATA OF EFFICACY

Abstract

Introduction: Granulocytapheresis has proved its efficacy in adult IBD(1).Granulocytemonocyte(GM) apheresis is carried out with a column filled with cellulose diacetate beads (Adacolumn, Japan Immunoreseach Laboratories, Takasaki, Japan) that adsorb circulating GM. Reduction of activated GM and its immunomodulatory effect(2) results in alleviation of inflammation and promotes remission. No severe side-effects have been reported. Methods: These are the preliminary data of a multicenter pilot study on efficacy, safety and tolerance of Granulocytapheresis in paediatric IBD. Steroid-refractory and steroid-dependent ulcerative colitis patients and Crohn’s disease patients unresponsive to conventional treatments, aged 12–18 years (weigth >30kgs), are eligible. Granulocytapheresis is performed as previously described (1). Results: Patient 1: 15 year-old boy, with active ileocolic Crohn’s disease and perianal fistula for two years. Previous treatments: enteral nutrition,5-ASA,azathioprine, antibiotics,infliximab. PCDAI before apheresis: 35. Sessions were well tolerated. No complications nor side effects owing to apheresis. 3 weeks after last session, he is in remission(PCDAI:5). No gastrointestinal symptoms, mild perianal disease and decreased inflammation markers. He has gained 4.8 kgs in two months. Patient 2: 14 year-old girl. Stricturing ileo-colic Crohn’s disease since 9 years of age without response to enteral nutrition,5-ASA, azathioprine, infliximab. PCDAI before apheresis: 52’5. Sessions well tolerated, no complications nor side-effects. No remission of her moderate flare-up (PCDAI30), no changes in inflammatory markers. Due to persistence of her symptoms, methrotexate treatment was begun. Conclusion: Granulocytapheresis is a safe and well tolerated treatment in paediatric IBD. We have not seen any complication nor side-effect due to the technique in our two patients. We hope to reach conclusions on its efficacy once our study is finished.