Leukapharesis for inflammatory bowel disease

Leukapheresis:

• involves extracorporeal removal of leukocytes from the blood, either by centrifugation or through an adsorptive system
• venous blood is removed in a continuous flow, anticoagulated, processed to deplete the leukocytes and returned to the circulation
  • different apheresis systems remove different populations of white blood cells
  • leukapheresis using centrifugation removes a proportion of neutrophils and lymphocytes
    • filter columns, which may contain cellulose acetate beads or a polyester fibre filter, remove a large proportion of granulocytes and monocytes and some also remove lymphocytes
    • exact mode of action of these procedures is unknown.

In ulcerative colitis:

• in one randomised controlled 74% (29/39) of patients treated with leukapheresis had an ‘excellent’ or ’moderate’ improvement in symptoms, compared with 38% (14/37) of patients treated with highdose steroids (p = 0.005)

In Crohn's disease:

• a small randomised controlled trial of patients with Crohn’s disease, 100% (12/12) of patients treated with leukapheresis were successfully withdrawn from steroid therapy, compared with 67% (10/15) of patients who were not treated with leukapheresis (p = 0.074)
  • no significant difference between the two groups in disease recurrence at 18-month follow-up

Reference:

1. NICE (July 2005). Leukapheresis for inflammatory bowel diseas