Granulocyte and Monocyte Apheresis for Induction of Remission in Children With New Onset Inflammatory Bowel Colitis.

Objective: To study 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 ten treatments with Adacolumn(R) (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 12-16 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 (PUCAI). Results: Twelve children (six girls) with a median age of 14.6 years and a median duration of symptoms at diagnosis of 3.2 months received all planned ten treatment sessions with ADA. 10/12 patients had pancolitis and 2/12 extensive colitis. However, a final diagnosis indicated ulcerative colitis in ten children and Crohn's disease in two children. At control colonoscopy, 8/12 children were in clinical remission and the Mayo endoscopic score showed significant improvement in 9/12 patients (p = 0.006). Complete microscopic remission, according to the Geboes score, was observed in two patients. Conclusion: In this small study GMA for induction of remission of newly onset pediatric IBD colitis was effective in 8/12 patients. Further controlled studies are warranted to confirm the efficacy of this treatment model. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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