Therapeutic Efficacy of Leukocytapheresis in a Pregnant Woman with Severe Active Ulcerative Colitis

Abstract

Leukocytapheresis has recently been used to induce remission in patients with ulcerative colitis (UC) who fail to respond to corticosteroids. We could not find a report in the literature on leukocytapheresis for UC with gestational exacerbation. We have recently encountered this unique condition and report the details here. A 30-year-old Japanese woman with left-sided severe UC was corticosteroid-dependent and had recurrence of the active disease during tapering of corticosteroid. She declined any dose increase and the use of any immunosuppressive agent because she was in the 13th week of pregnancy. Then, concomitant leukocytapheresis was performed without increasing the corticosteroid dose. Recovery was rapid and dramatic. Mucous and bloody stool decreased after the first session, and she had remission 2 weeks later. She underwent a total of four sessions without complications. After 6 weeks, she was discharged from our hospital and underwent maintenance treatment as an outpatient with mesalazine and corticosteroid tapering. Subsequently, she gave birth to a healthy baby girl by an uncomplicated vaginal delivery while keeping the remitted stage of UC.

Therapeutic Efficacy of Leukocytapheresis in a Pregnant Woman with Refractory Adult-onset Still's Disease

“…LCAP has been performed in pregnant patients with chronic myeloid leukemia (24), RA (25) and UC (26,27), demonstrating its safety for both mothers and fetuses. However, LCAP can result in anemia.…”

Tratamiento con aféresis en la enfermedad inflamatoria intestinal

“…Se han publicado varios trabajos en este grupo de pacientes, lo que demuestra que la técnica es segura y útil para el control del brote y el descenso de la dosis de los esteroides 14,43 . Recientemente se ha publicado un caso en el que se ha mostrado eficaz y segura en una paciente embarazada, sin daños en el feto ni en la evolución de la gestación 44 .…”

Letter: leucocytapheresis as a nonpharmacologic treatment for patients with ulcerative colitis during pregnancy

“…Unfortunately, this review makes no mention of leucocytapheresis, which has been reported as an effective therapy in pregnant IBD patients. [2][3][4] In the report by Okada et al, 2 a 30-year-old pregnant woman with UC had relapsed during tapering of corticosteroid. Leucocytapheresis was performed without increasing the corticosteroid dose.…”

“…SIRS, Yamamoto et al kindly discussed our article and point out that leucocytapheresis has not been mentioned as a therapeutic option in pregnant patients with inflammatory bowel disease (IBD) in our review. 1,2 We are well aware of this treatment option and have treated a significant number of patients both in clinical studies 3 and individual clinical settings with leucocytapheresis, especially patients refractory to conventional treatment.…”