Efficacy and safety of rituximab in auto-immune hemolytic anemia: A meta-analysis of 21 studies

Reynaud, Quitterie; Durieu, I.; Dutertre, M.; Ledochowski, Stanislas; Durupt, S.; Michallet, Anne‐Sophie; Vital-Durand, D; Lega, Jean‐Christophe

doi:10.1016/j.autrev.2014.11.014

Cited by 109 publications

(76 citation statements)

References 40 publications

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“…The OR was similar regardless of whether it was idiopathic or secondary AIHA (67% vs 72%). 43 In studies with .3 years of follow-up, the relapse rate was ;50%. However, most patients responded to rituximab retreatment.…”

Section: What Is the Value Of Splenectomy?mentioning

confidence: 98%

How I treat autoimmune hemolytic anemia

Go¹,

Winters

Kay³

2017

Blood

151

113

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Autoimmune hemolytic anemia (AIHA) is an uncommon entity that presents diagnostic, prognostic, and therapeutic dilemmas despite being a well-recognized entity for over 150 years. This is because of significant differences in the rates of hemolysis and associated diseases and because there is considerable clinical heterogeneity. In addition, there is a lack of clinical trials required to refine and update standardized and evidence-based therapeutic approaches. To aid the clinician in AIHA management, we present four vignettes that represent and highlight distinct clinical presentations with separate diagnostic and therapeutic pathways that we use in our clinical practice setting. We also review the parameters present in diagnostic testing that allow for prognostic insight and present algorithms for both diagnosis and treatment of the AIHA patient in diverse situations. This is done in the hope that this review may offer guidance in regard to personalized therapy recommendations. A section is included for the diagnosis of suspected AIHA with negative test results, a relatively infrequent but challenging situation, in order to assist in the overall evaluation spectrum for these patients. (Blood. 2017; 129(22):2971-2979

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Section: What Is the Value Of Splenectomy?mentioning

confidence: 98%

How I treat autoimmune hemolytic anemia

Go¹,

Winters

Kay³

2017

Blood

151

113

View full text Add to dashboard Cite

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“…43 However, response rates and lasting responses to this treatment are not optimal. 19 In our cohort, 48% (n 5 14) of patients received rituximab treatment, with 86% (12 of 14) of these patients experiencing severe (50%) or moderate (36%) anemia following treatment. This is consistent with the literature, where rituximab studies show a low response rate and slow time to response.…”

Section: Discussionmentioning

confidence: 82%

“…This is consistent with the literature, where rituximab studies show a low response rate and slow time to response. 19,21,39 Combination rituximab/ fludarabine treatment has shown efficacy with the tradeoff of high toxicity. 21 One of the patients described in this study (patient 209) received rituximab/fludarabine combination therapy near the end of their follow-up time, so response could not be determined at this time.…”

Section: Discussionmentioning

confidence: 99%

“…18 Rituximab has not been extensively studied in CAD; however, meta-analyzed data show a response in only 57% of CAD cases, with complete responses observed in only 21% of CAD patients and a slow response time. 19 Furthermore, the duration of response with rituximab was reported as only 6.5 months in Schöllkopf et al 20 and 11 months in Berentsen et al 17 The most effective CAD treatment reported in the literature is a combination of rituximab and fludarabine, providing 76% response and a median response duration of 66 months. 21 However, toxicity was a serious concern, 21,22 with 41% (n 5 12) of patients having grade 3-4 toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Cold agglutinin disease burden: a longitudinal analysis of anemia, medications, transfusions, and health care utilization

et al. 2017

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“…2,22 In a recently published meta-analysis of 21 studies younger age and wAIHA were confirmed as predictive factors for overall and complete response rate following rituximab therapy. 28 Rituximab in some special presentations of wAIHA Chronic lymphocytic leukemia-associated AIHA Autoimmune cytopenias are well-known complications of chronic lymphocytic leukemia (CLL), AIHA being the most common with an estimated incidence of up to 10%. 29 CLL patients with AIHA seem to have a better prognosis compared with those with advanced stage (Binet C) showing anemia due to bone marrow infiltration, but have a worse survival compared with early stage (Binet A) patients without anemia.…”

Section: How Does Rituximab Work?mentioning

confidence: 99%

The role of rituximab in adults with warm antibody autoimmune hemolytic anemia

Dierickx

Kentos

Delannoy

2015

Blood

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Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia. When therapy is needed, corticosteroids remain the cornerstone of initial treatment but are able to cure only a minority of patients (<20%). Splenectomy is usually proposed when a second-line therapy is needed. This classical approach is now challenged by the use of rituximab both as second-line and as first-line therapy. Second-line treatment with rituximab leads to response rates similar to splenectomy (∼70%), but rituximab-induced responses seem less sustained. However, additional courses of rituximab are most often followed by responses, at the price of reasonable toxicity. In some major European centers, rituximab is now the preferred second-line therapy of warm antibody hemolytic anemia in adults, although no prospective study convincingly supports this attitude. A recent randomized study strongly suggests that in first-line treatment, rituximab combined with steroids is superior to monotherapy with steroids. If this finding is confirmed, rituximab will emerge as a major component of the management of warm antibody hemolytic anemia not only after relapse but as soon as treatment is needed.

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Efficacy and safety of rituximab in auto-immune hemolytic anemia: A meta-analysis of 21 studies

Cited by 109 publications

References 40 publications

How I treat autoimmune hemolytic anemia

How I treat autoimmune hemolytic anemia

Cold agglutinin disease burden: a longitudinal analysis of anemia, medications, transfusions, and health care utilization

The role of rituximab in adults with warm antibody autoimmune hemolytic anemia

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