title: Adsorptive Monocyte-granulocytapheresis (M-GCAP) for refractory Crohn's disease.
abstract: Six patients with active Crohn's disease (CD) unresponsive to conventional medications (CM) were treated with Monocyte-granulocytapheresis (M-GCAP). CD patients who scored 200-400 points in Crohn's disease activity index (CDAI) in spite of receiving CM, including enteral nutrition, for at least 2 weeks were enrolled in our double series trial. Each series had 5 weekly M-GCAP and 2 follow-up weeks, and each M-GCAP treated 1,800 ml of patient's peripheral blood. After the 1st series, patients who decreased more than 50 points on the CDAI were deemed responders and enrolled in the second series. Patients with a CDAI score less than 150 points were considered in remission. The patients' quality of life was evaluated using an index (IBDQ) before and after the 1st series. The CDAI was significantly decreased comparing before and after the 1st series (258.2 +/- 36.2 vs. 166.5 +/- 16.6; P < 0.02). 50% of patients (3/6) responded to the therapy, and one case (16.7%) could be induced to remission. Significant removal was revealed only for white blood cells (25.6 +/- 16.9%; P < 0.05), especially granulocytes (29.5 +/- 22.5%; P < 0.05). A statistically significant improvement of IBDQ was revealed in the responders' group (162.3 +/- 17.2 vs. 189.3 +/- 11.5; P < 0.03). M-GCAP could be an effective adjunctive therapy for active CD patients unresponsive to CM allowing them to maintain a high QOL. However, it might be difficult to improve patients who could not be induced to remission after the 1st series by applying another series.
authors.affiliation: The Division of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kusaka
authors.forename: Ken
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Kunio
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Tomita
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Koji
authors.initials: K
authors.lastname: Sawada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D001772:Blood Cell Count; D003424:Crohn Disease / Q000628:therapy*; D005260:Female; D006098:Granulocytes / Q000166:cytology*; D006801:Humans; D015212:Inflammatory Bowel Diseases; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D009000:Monocytes / Q000166:cytology*; D011788:Quality of Life; D012074:Remission Induction; D013997:Time Factors