Leukocytapheresis: An "Out-of-Body" Experience in Inflammatory Bowel Disease

Leukocytapheresis has reemerged as a novel "nondrug" approach in the treatment of inflammatory bowel disease. The technique involves the extracorporeal passage of peripheral blood through a column of cellulose diacetate beads (Adacolumn) or a nonwoven polyester fiber filter (Cellsorba). The benefits accrued from the filtered extraction of granulocytes, monocytes (Adacolumn), and lymphocytes (Cellsorba) appear greater than the simple extraction of these cells. There appears to be an immunologic modulation of leukocytes and dendritic cells and a diminished response to proinflammatory cytokines. Unfortunately, blinded placebo-controlled trials are lacking. Nevertheless, the aggregate clinical experience detailed in this review suggests a relatively safe and attractive alternative to current inflammatory bowel disease therapies. Randomized, controlled sham trials are in progress.