title: Effect and safety of granulocyte-monocyte adsorption apheresis for patients with ulcerative colitis positive for cytomegalovirus in comparison with immunosuppressants.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies (IMT). However, the underlying UC remained active in some UC patients, despite the fact that CMV-DNA in colonic mucosa became negative after antiviral therapy. Therefore, new therapeutic strategies for UC patients concomitant with CMV infection in mucosa are required.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effect and safety of granulocyte-monocyte adsorption apheresis (GMA) in UC patients positive for CMV infection after antiviral therapy.
  
  
  METHODS
  From October 2003 to December 2008, 64 patients with UC refractory to IMT, including steroids and immunomodulators, were enrolled in this retrospective, observational, multicenter study, which was reviewed and approved by the Institutional Review Board of Kyoto University. CMV infection was investigated by 3 methods (histologic examination, CMV antigenemia, and polymerase chain reaction). We investigated the clinical outcomes of GMA and IMT after 2 weeks of treatment with ganciclovir.
  
  
  RESULTS
  Thirty-one (48.4%) of 64 patients with UC refractory to IMT were positive for CMV. Of the 31 patients, 4 (12.9%) underwent colectomy. Twenty-seven patients (87.1%) underwent antiviral therapy. Of those 27 patients, 7 achieved remission following antiviral therapy alone. Of the remaining 20 patients who did not achieve remission despite the disappearance of CMV-DNA, 11 and 9 patients were treated with additional GMA (GMA group) and IMT (IMT group), respectively. Of 11 patients (GMA group), 9 achieved remission and 2 underwent colectomy. Out of the remaining 9 patients (IMT group), 4 achieved remission and 5 underwent colectomy. CMV-DNA was not detected in 11 patients after GMA, but it was detected again in all 5 patients of the IMT group who underwent colectomy. The total colectomy rate in UC patients positive for CMV was 35.5% (11/31). In addition, colectomy-free survival in the CMV relapse (+) group was estimated to be 12.9% at 65 months, while that in the CMV relapse (-) group was estimated to be 100% at 60 months.
  
  
  CONCLUSIONS
  The colectomy ratio tends to be high in refractory UC patients with recurrent CMV reactivation or infection. Therefore, GMA might be a safe and effective treatment for UC patients positive for CMV because it does not induce CMV reactivation.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yoshino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuura
authors.forename: Kayoko
authors.initials: K
authors.lastname: Matsumura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Honzawa
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukuchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Mitsuyuki
authors.initials: M
authors.lastname: Murano
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tsujikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000293:Adolescent; D000327:Adsorption; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000401:mortality / Q000628:therapy* / Q000821:virology; D003131:Combined Modality Therapy; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000628:therapy* / Q000821:virology; D015774:Ganciclovir / Q000008:administration & dosage; D006098:Granulocytes / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007937:Leukapheresis; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology*; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir