LEUKOCYTAPHERESIS THERAPY, PERFORMED WITH LEUKOCYTE REMOVAL FILTER, FOR INFLAMMATORY BOWEL-DISEASE

Leukocytapheresis (LCAP), performed with a leukocyte removal filter, w as administered five times, at 1-week intervals, for 5 weeks of intens ive therapy and five times, at approximately 1-month intervals, for ap proximately 5 months of maintenance therapy, to 13 patients with infla mmatory bowel disease (IBD) diagnosed as ulcerative colitis (UC) in 8 and Crohn's disease (CD) in 5. Clinical and blood examinations showed no side effects in any of the patients. During the intensive therapy, excellent or moderate clinical response was recognized in 11 of the 13 patients (84.6%), of whom 6 had a dramatic response; the excellent or moderate clinical response continued throughout the maintenance thera py in 8 of the patients (61.5%). Flow cytometry showed that the patien ts who had improved generally had high values for percentages of HLADR +, HLADR+CD3+, and HLADR+CD8+ cells before the first LCAP, and that th ese values and the C-reactive protein levels and erythrocyte sedimenta tion rates had decreased to the normal range by the end of both intens ive and maintenance therapy. In the patients who showed poor response, in contrast, all the above values had been at or near normal before t he initial LCAP administration. The clinical improvement in the absenc e of any additional medical treatment suggests that LCAP has the capac ity to influence the causal mechanism(s) of IBD and that IBD is strong ly associated with the cell-mediated immune response.