title: Safety and efficacy of granulocyte and monocyte adsorption apheresis in paediatric inflammatory bowel disease: a prospective pilot study.
abstract: OBJECTIVE
  Selective granulocyte-monocyte adsorption (GMA) apheresis is a safe technique that has shown efficacy in inflammatory bowel disease (IBD), especially in adult steroid-dependent and steroid-refractory ulcerative colitis. GMA apheresis is performed with Adacolumn, a direct blood perfusion system that selectively adsorbs circulating granulocytes and monocytes. Studies on efficacy of GMA apheresis in paediatric IBD are scarce. Our aim was to evaluate efficacy, safety, and tolerability of GMA apheresis in paediatric IBD patients followed for 1 year.
  
  
  METHODS
  Nine patients with a mild to moderate flare-up (6 boys, 3 girls; 5 ulcerative colitis [UC], 4 Crohn disease [CD]) were included. Mean age at inclusion was 13 years and 9 months, and mean disease duration before inclusion was 28 months. All of our patients with UC were steroid-dependent; patients with CD had been unsuccessfully treated with other therapies. GMA apheresis consisted of 5 consecutive weekly sessions lasting 60 minutes each.
  
  
  RESULTS
  After the 5 sessions, 4 of 5 patients with UC and 1 of 4 patients with CD achieved remission. This remission was maintained in 2 of 4 patients with UC and in the single patients with CD. Patients taking steroids could begin to taper their daily doses after the second apheresis, and 3 of 5 of these patients reached the end of the study steroid-free. GMA apheresis was well tolerated and no severe side effects related to the technique were observed.
  
  
  CONCLUSIONS
  GMA apheresis is a safe, well-tolerated technique in paediatric IBD. As previously reported, we have observed a better efficacy in promoting and maintaining remission, and reducing conventional drugs in patients with UC than in patients with CD.
authors: Department of Paediatric Gastroenterology, Hepatology, and Nutrition, Hospital Sant Joan de Déu, Barcelona, Spain. javiermartin@hsjdbcn.org
authors: Javier
authors: J
authors: Martín de Carpi
authors: Pere
authors: P
authors: Vilar
authors: Gerardo
authors: G
authors: Prieto
authors: María Dolores
authors: MD
authors: García Novo
authors: Carmen
authors: C
authors: Ribes
authors: Vicente
authors: V
authors: Varea
mesh_terms: D000293:Adolescent; D000327:Adsorption; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology / Q000628:therapy*; D003424:Crohn Disease / Q000473:pathology / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007937:Leukapheresis / Q000379:methods*; D008297:Male; D009000:Monocytes; D010865:Pilot Projects; D011446:Prospective Studies; D012074:Remission Induction; D012449:Safety; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents