The current status of T-lymphocyte apheresis (TLA) treatment of Crohn's disease.
After establishing criteria of patient selection, disease activity and, remission we performed lymphoplasmapheresis in seven patients with severely active chronic Crohn's disease. Five of the seven responded, but the results were unpredictable, not cost-effective, and had 100% morbidity. We then changed the protocol to selectively remove T-cells by differential ultracentrifugation. The initial goal was to remove 40 times 10(9) T-cells, but it was changed to 80 times 10(9) in order to increase the length of remission. We found that all patients with steroid-dependent chronically active Crohn's disease show evidence of protein calorie malnutrition. We used total parenteral nutrition with T-lymphocyte apheresis in the last 21 of 25 patients so treated. We have now completed a series of 54 patients, achieving a statistically valid remission, lasting an average of more than 18 months, in 48 of them. Criteria of remission included absolute zero steroid dosage. There has been no mortality or evidence of immunocompromise. The only morbidity (four patients) was the need for intravenous catheters during the apheresis procedure. This work has been confirmed elsewhere. Immune studies in active, untreated disease show low serum values of interleukin-2, as well as abnormalities of T-cell responsiveness to interleukin-2. The mechanism of how T-lymphocyte apheresis works is not clear, but it represents a promising new approach to the treatment of Crohn's disease.
Bicks
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Baptist Memorial Hospital, Memphis, TN 38103.
Groshart
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KD
D003424:Crohn Disease / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis; D013601:T-Lymphocytes / Q000637:transplantation*