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Granulocyte and Monocyte Apheresis for Induction of Remission in Children With New-Onset Inflammatory Bowel Colitis
Södersjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden; Södersjukhuset, Sachs Children & Youth Hosp, Dept Gastroenterol, Stockholm, Sweden.
Södersjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden; Danderyd Hosp, Dept Gastroenterol, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
Södersjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden; Södersjukhuset, Sachs Children & Youth Hosp, Dept Gastroenterol, Stockholm, Sweden.
2018 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 66, no 1, p. 84-89Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the study was to analyze the effect of granulocyte and monocyte apheresis (GMA) with mesalazine for induction of remission in pediatric patients with newly onset chronic inflammatory bowel disease (IBD) colitis.

Methods: Thirteen pediatric patients with newly onset extensive IBD colitis were investigated per the ECCO/ESPGHAN IBD protocol. Of these 13, 12 received 10 treatments with Adacolumn (ADA) during a median of 6.25 weeks in combination with low-to-moderate doses of mesalazine, which was continued after apheresis. A control colonoscopy was performed 12 to 16 weeks after GMA treatment. Primary outcomes were mucosal healing (Mayo endoscopic score) and histopathologic grading of biopsies. A secondary outcome was disease activity as measured by the Pediatric Ulcerative Colitis Activity Index.

Results: Twelve children (6 girls) with a median age of 14.6 years and a median duration of symptoms at diagnosis of 3.2 months received all planned 10 treatment sessions with ADA. Ten of 12 patients had pancolitis and 2 of 12 extensive colitis. A final diagnosis, however, indicated ulcerative colitis in 10 children and Crohn disease in 2 children. At control colonoscopy, 8 of 12 children were in clinical remission and the Mayo endoscopic score showed significant improvement in 9 of 12 patients (P = 0.006). Complete microscopic remission, according to the Geboes score, was observed in 2 patients.

Conclusions: In this small study GMA for induction of remission of newly onset pediatric IBD colitis was effective in 8 of 12 patients. Further controlled studies are warranted to confirm the efficacy of this treatment model.

Place, publisher, year, edition, pages
2018. Vol. 66, no 1, p. 84-89
Keywords [en]
Crohn disease, leukapheresis, pediatric patients, ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-348791DOI: 10.1097/MPG.0000000000001641ISI: 000425389400028PubMedID: 28604509OAI: oai:DiVA.org:uu-348791DiVA, id: diva2:1200618
Funder
The Kempe FoundationsAvailable from: 2018-04-24 Created: 2018-04-24 Last updated: 2018-04-24Bibliographically approved

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Fagerberg, Ulrika L.

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