title: Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes.
abstract: BACKGROUND
  Hitherto, therapeutic depletion of granulocytes and monocytes by adsorption (GMA) has been associated with significant and insignificant efficacy in patients with ulcerative colitis (UC). Further, the processed blood volume in one GMA session has been fixed at 30 mL/min × 60 min, regardless of patients' body weight (BW). We were interested to see the efficacy and safety of GMA when administered in relation to patients' BW.
  
  
  METHODS
  Sixty patients were randomly assigned to the routine GMA (n = 30) and to GMA adjusted to patients' BW, 60 mL/kg (n = 30). GMA was done with the Adacolumn, up to 10 sessions over 10 weeks. At entry and 1 week post last GMA, patients were clinically and endoscopically evaluated. Remission was defined as clinical activity index (CAI) ≤4, whereas mucosal remission was defined as endoscopic index (EI) ≤3.
  
  
  RESULTS
  In the BW group, the processed volume/session was 3,260 ± 581 versus 1,800 mL in the routine group (P < 0.001). In the BW group, 25 of 30 patients (83.3%) achieved remission versus 19 of 30 patients (63.3%) in the routine group. The average CAI in the BW group fell from 9.6 ± 2.6 to 2.3 ± 2.1 versus from 9.1 ± 2.4 to 4.0 ± 2.1 (P < 0.05) in the routine group. Similarly, the EI in the BW group fell from 9.4 ± 1.3 to 2.1 ± 2.1 versus from 9.2 ± 1.8 to 4.5 ± 2.3 (P < 0.01).
  
  
  CONCLUSIONS
  GMA adjusted to patients' BW and at a vastly greater processed volume produces significantly higher efficacy as compared with the routine GMA protocol. Further, in this study, up to twofold higher processed volume caused no safety concern.
authors.affiliation: Department of Internal Medicine, Social Insurance Central General Hospital, 3-22-1 Hyakunin cho, Shinjuku-ku, Tokyo 169-0073, Japan. ynaokun@yahoo.co.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Tokuma
authors.initials: T
authors.lastname: Tadami
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Minako
authors.initials: M
authors.lastname: Sako
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshimoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamaka
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takazoe
mesh_terms: D000293:Adolescent; D000328:Adult; D001810:Blood Volume; D001835:Body Weight; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000628:therapy*; D003113:Colonoscopy / Q000379:methods; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D009000:Monocytes / Q000378:metabolism; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult