Rituximab in auto‐immune haemolytic anaemia and immune thrombocytopenic purpura: a Belgian retrospective multicentric study

Dierickx, Daan; Verhoef, Gregor; Hoof, A. van; Mineur, Philippe; Roest, Annelieke M.; Triffet, Agnès; Kentos, Alain; Pierre, P.; Boulet, Dominique; Bries, G.; Le, P-Q; Janssens, Ann; Delannoy, André

doi:10.1111/j.1365-2796.2009.02126.x

Cited by 70 publications

(73 citation statements)

References 40 publications

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“…All patients remained in either CR or PR, at a mean follow-up of 604 days. Several retrospective studies in population of refractory primary or secondary AIHA confirmed the efficacy of rituximab [54][55][56][57][58][59]. The potential long-term complications of rituximab were reported by Carson et al [60], i.e., progressive multifocal leukoencephalopathy in two patients in 57 cases.…”

Section: Discussionmentioning

confidence: 90%

Warm Autoimmune Hemolytic Anemia: Clinical Profile and Management

Sudulagunta¹,

Kumbhat

Sodalagunta

et al. 2017

J Hematol

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Background: Autoimmune hemolytic anemia (AIHA) is a rare autoimmune disease in which autoantibodies target red blood cells leading to marked decrease in their lifespan. The classification of AIHA is based on the immunochemical properties of the RBC autoantibody. Warm antibody AIHA (wAIHA) accounts for 75-80% of all adult AIHA cases. The treatment of wAIHA is mainly corticosteroids. Our retrospective study aimed to study the clinical profile and management of wAIHA.

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Section: Discussionmentioning

confidence: 90%

Warm Autoimmune Hemolytic Anemia: Clinical Profile and Management

Sudulagunta¹,

Kumbhat

Sodalagunta

et al. 2017

J Hematol

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“…Recent reviews 31,32 reported that rituximab (375 mg/m 2 weekly for a median of 4 weeks) is effective in treating both warm AIHA and CAD, with a median response rate higher in the warm forms (overall response (OR) 83-87%, complete response (CR) 54-60% vs. OR 58%, CR 4.5%); disease free survival has been reported to be 72% at one and 56% at two years. 33 Rituximab has been shown to be effective both in idiopathic and secondary AIHA, including those associated with autoimmune and lymphoproliferative disorders, and bone marrow transplant. 31,32,[34][35][36][37] Responses to treatment were observed in monotherapy or in combination with corticosteroids, immunosuppressants and interferon-α, 35,36 and regardless of prior therapy.…”

Section: Rituximabmentioning

confidence: 99%

Treatment of autoimmune hemolytic anemias

2014

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Autoimmune hemolytic anemia (AIHA) is a relatively uncommon disorder caused by autoantibodies directed against self red blood cells. It can be idiopathic or secondary, and classified as warm, cold (cold hemagglutinin disease (CAD) and paroxysmal cold hemoglobinuria) or mixed, according to the thermal range of the autoantibody. AIHA may develop gradually, or have a fulminant onset with life-threatening anemia. The treatment of AIHA is still not evidence-based. The first-line therapy for warm AIHA are corticosteroids, which are effective in 70-85% of patients and should be slowly tapered over a time period of 6-12 months. For refractory/relapsed cases, the current sequence of second-line therapy is splenectomy (effective approx. in 2 out of 3 cases but with a presumed cure rate of up to 20%), rituximab (effective in approx. 80-90% of cases), and thereafter any of the immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporin, mycophenolate mofetil). Additional therapies are intravenous immunoglobulins, danazol, plasma-exchange, and alemtuzumab and high-dose cyclophosphamide as last resort option. As the experience with rituximab evolves, it is likely that this drug will be located at an earlier point in therapy of warm AIHA, before more toxic immunosuppressants, and in place of splenectomy in some cases. In CAD, rituximab is now recommended as first-line treatment. ABSTRACT Treatment of warm AIHAThe traditional treatment of AIHA includes corticosteroids, splenectomy and conventional immunosuppressive drugs. Over recent years, some new therapies have become available and there has been some evidence of success. These therapies are primarily used in patients who are not candidates for or fail to respond to splenectomy, those who relapse after splenectomy, and those who cannot maintain stable hemoglobin levels without unacceptably high doses of corticosteroids. First-line therapy CorticosteroidsThere is general agreement that corticosteroids represent the first-line treatment for patients with warm antibody type AIHA, albeit their use is based on experience rather than hard evidence. In fact, there is little published information on their effectiveness, 1,16,17 and this is not supported by clinical trials. Corticosteroids, usually prednisone, are given at the initial dose of 1.0-1.5 mg/kg/day for 1-3 weeks until hemoglobin levels greater than 10 g/dL are reached. Response occurs mainly during the second week, and if none or minimal improvement is observed in the third week, this therapy is assumed to be ineffective. After stabilization of hemoglobin, prednisone should be gradually and slowly tapered off at 10-15 mg weekly to a daily dose of 20-30 mg, then by 5 mg every 1-2 weeks until a dose of 15 mg, and subsequently by 2.5 mg every two weeks with the aim of withdrawing the drug. Although one might be tempted to discontinue steroids more rapidly, AIHA patients should be treated for a minimum of three or four months with low doses of prednisone (≤10 mg/day).1 In fact, patients receiving low doses of cortico...

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“…In this study, which had a very similar design as the study of Penalver et al, we reported on 53 patients with refractory AIHA treated with rituximab. Compared with the Spanish results overall response rates (79%) were similar, although the rate of complete responses (CR) was lower (47%) [2]. The reason for this difference is not clear as definition of CR and proportion of patients with cold type AIHA, a subtype in which the achievement of CR with rituximab monotherapy is rather rare, were similar [3].…”

Section: Dear Editormentioning

confidence: 86%

“…In our series nine patients were re-challenged with rituximab, leading to overall response characteristics similar to the responses achieved after the first course, including in some cases even longer response duration after rituximab re-treatment. In addition, one patient achieved a partial response although first rituximab course failed [2].…”

Section: Dear Editormentioning

confidence: 99%