Ps1158 Ibrutinib Plus Rituximub in Steroid Refractory Autoimmune Hemolytic Anemia: Elaboration of Treatment Approach (Israel): An Interim Analysis of the Rohs Trial

Abstract

effectiveness of rituximab-based chemotherapy in first-line (treatment cohort 1), but failed to demonstrate a benefit in the second-line setting (treatment cohort 2; Table 1). Furthermore, no evidence was found that prior rituximab exposure was associated with the effectiveness of rituximab-based chemotherapy in second-line (treatment cohort 3). Covariates associated with inferior TFS in that particular cohort were age per one-year increase and first-line therapy with a backbone of purine analogues, as compared with a backbone of alkylating agents. Conversely, patients with a longer time to next treatment had better TFS. Summary/Conclusion:In this comprehensive, population-based study, the effectiveness of first-line treatment with rituximab-based chemotherapy was not objectivated in second-line treatment. The lack of effectiveness of rituximab-based chemotherapy in second-line could not be explained by previous rituximab exposure.

Autoimmune Cytopenia in CLL

“…Results of ibrutinib as a treatment for CLL-related AIHA have been described in the form of various case reports and small case series, including ITP, ES, and PRCA, with an ORR near 100% 46,137–143 Table 6. summarizes the detailed results of these studies.…”

“…A phase II clinical trial (NCT03827603) is investigating the efficacy of continuous ibrutinib plus rituximab given as 8 weekly infusions followed by a maintenance phase for the treatment of AIHA refractory to corticosteroids in patients with CLL. The preliminary results including 37 patients (32 AIHA, 5 PRCA) of whom 23 had completed the initial phase of treatment did show an ORR of 95% in AIHA and 80% in PRCA 143 . Similarly, other BTKis are currently being investigated in cases with primary and refractory ITP and other autoimmune diseases (NCT03395210) 144,146 …”

“…Results of ibrutinib as a treatment for CLL-related AIHA have been described in the form of various case reports and small case series, including ITP, ES, and PRCA, with an ORR near 100%. 46,[137][138][139][140][141][142][143] Table 6 summarizes the detailed results of these studies. Of note, in a study, it was found that an ibrutinib-related flare-up effect was associated with worsening of cytopenia, in which, however, it was followed by a dramatic response if ibrutinib was not discontinued.…”

“…The preliminary results including 37 patients (32 AIHA, 5 PRCA) of whom 23 had completed the initial phase of treatment did show an ORR of 95% in AIHA and 80% in PRCA. 143 Similarly, other BTKis are currently being investigated in cases with primary and refractory ITP and other autoimmune diseases (NCT03395210). 144,146…”