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Granulocyte adsorptive apheresis for pediatric patients with ulcerative colitis
Takeshi Tomomasa1, Akio Kobayashi, Hiroaki Kaneko
1Department of Pediatrics, Gunma University Faculty of Medicine, Maebashi, Japan.
Insights
Granulocytapheresis (GCAP) effectively treats pediatric ulcerative colitis (UC) by reducing inflammation. This therapy shows good tolerance and sustained remission in many children with steroid-refractory UC.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Inflammatory Bowel Disease
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting children.
- Steroid-refractory UC poses a significant treatment challenge in pediatric populations.
- Granulocytapheresis (GCAP) is an extracorporeal treatment that removes activated immune cells.
Purpose of the Study:
- To evaluate the efficacy and safety of GCAP in pediatric patients with active, steroid-refractory ulcerative colitis.
- To assess clinical and endoscopic outcomes following GCAP treatment in children.
Main Methods:
- Retrospective investigation of twelve pediatric patients with active UC, refractory to steroids.
- GCAP administered weekly for 5-10 consecutive weeks.
- Steroid dosage tapered by 50% during GCAP therapy.
Main Results:
- Eight out of twelve patients showed clinical improvement after two GCAP sessions.
- Significant improvements observed in body temperature, stool frequency, and rectal bleeding.
- Endoscopic scores improved from 2.6 to 0.4.
- Four patients relapsed 3.5 months post-treatment; four remained in remission for up to 22.8 months.
- No serious adverse effects were reported.
Conclusions:
- GCAP is a potentially effective and well-tolerated treatment option for pediatric steroid-refractory UC.
- GCAP can lead to clinical remission and endoscopic improvement in a significant proportion of children.
- Long-term remission is achievable, though relapse can occur, necessitating maintenance strategies.
Abstract:
Granulocytapheresis (GCAP) has produced efficacy in adult patients with ulcerative colitis (UC) by adsorbing activated granulocytes and monocytes/macrophages. We retrospectively investigated efficacy and safety of GCAP in pediatric patients with active UC. Twelve steroid-refractory children (12.2 +/- 3.1 years old) were treated with GCAP, one session/week for 5-10 consecutive weeks. In 8 patients, clinical symptoms improved after two GCAP sessions. Normal body temperature, stool frequency, and disappearance of blood in stool were seen after 24.3 +/- 11.5 days. The endoscopic grade improved from 2.6 +/- 0.3 to 0.4 +/- 0.2. One patient who initially responded, developed bloody diarrhea later and 2 cases remained unchanged. The dose of steroid was tapered during GCAP therapy by 50%. No serious adverse effects were noted. Four of 8 cases relapsed 3.5 +/- 2.2 months after the last GCAP while on maintenance therapy, the other 4 were in remission up to 22.8 +/- 18.1 months. In conclusion, GCAP appears to be effective and well tolerated in children with steroid-refractory UC.