Generally, the most effective treatment for advanced
primary biliary cirrhosis (PBC) is
liver transplantation, but adjunct
therapies are needed. We report here a first case of advanced PBC treated with a new
immunotherapy, granulocyte and monocyte
apheresis (GCAP). A column (Adacolumn, Japan Immunoresearch Laboratory Takasaki, Japan) was filled with
cellulose acetate beads to selectively adsorb granulocytes and monocytes/macrophages. A 49-year-old woman was diagnosed with PBC in 1987. In June 2001,
steroid pulse
therapy and adjuvant fresh frozen plasma was given for moderate
jaundice but without success. In July, as total
bilirubin rapidly increased, treatment with GCAP was started and succeeded in suppressing the rapid deterioration of total
bilirubin (value changes after each of four applications: 15.4-->14.0, 27.2-->25.1, 25.8-->24.0, 25.7-->23.7 mg/dL) and improving prothrombin time (16.4-->14.5 s). Although GCAP
therapy did not prevent a fatal outcome, it suppressed rapid deterioration of
jaundice and increased quality of life for a month.