Rituximab therapy in a patient with autoimmune hemolytic anemia and immune thrombocytopenia associated with chronic lymphocytic leukemia

Aleem, Aamer

doi:10.5144/0256-4947.2008.382

Cited by 2 publications

(4 citation statements)

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“…Cytoxan, vincristine, high‐dose IVIg, and splenectomy have also been used, mainly in cases with steroid‐refractory forms. More recently, anecdotal cases of IT‐complicating CLL treated with anti‐CD20 monoclonal antibody rituximab have been published (9–11). Rituximab is active against normal and neoplastic B‐lymphocytes that express the CD20 antigen, including CLL cells, despite their lower density of CD20 compared to normal B‐lymphocytes, and in other B‐lymphoproliferative disorders (21).…”

Section: Discussionmentioning

confidence: 99%

“…So far, very few patients with CLL have been treated with rituximab for their IT, with encouraging results (9–11). We retrospectively evaluated 21 patients with CLL‐related IT treated at our Institutions in the last 8 yr, with a weekly rituximab infusions schedule for four consecutive weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Steroids, cyclosporine A, splenectomy, cytotoxic agents are used according to the treatments usually used for idiopathic thrombocytopenic purpura. More recently, patients treated with monoclonal antibodies rituximab and alemtuzumab have been reported, despite anecdotally, with encouraging results (9–11).…”

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confidence: 99%

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Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

D’Arena

Capalbo

Laurenti

et al. 2010

European J of Haematology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

D’Arena

Capalbo

Laurenti

et al. 2010

European J of Haematology

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“…Rituximab, 57 Alemtuzumab 58 and Veltuzumab 59 have been reported to be effective in CLL associated AIT. 60 , 61 Most of the published literature about rituximab is in primary immune thrombocytopenic purpura.…”

Section: Managementmentioning

confidence: 99%

Autoimmune Cytopenias in Chronic Lymphocytic Leukemia, Facts and Myths

Tandra

Krishnamurthy

Bhatt

et al. 2013

Mediterr J Hematol Infect Dis

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CLL has been defined as presence of more than 5000 small mature appearing monoclonal B lymphocytes with a specific immunophenotype in peripheral blood. It is a well-known fact that CLL is associated with autoimmune cytopenias. CLL cells are CD5+ B lymphocytes, and usually are not the “guilty” cells which produce autoantibodies. T cell defect is another characteristic of CLL and the total number of T cells is increased, and there is inversion of the CD4/CD8 ratio. Autoimmune hemolytic anemia (AIHA) is the most common autoimmune complication of CLL and has been reported in 10–25% of CLL patients. However, the stage-adjusted estimated rate of AIHA in CLL is about 5%. Conversely, CLL is three times more common in patients who present with AIHA. Direct agglutinin test (DAT) is positive in 7–14% of CLL patients but AIHA may also occur in DAT negative patients.Autoimmune thrombocytopenia (AIT) is the second most common complication of CLL and has been reported in 2–3% of patients. DAT is positive in AIT but presence of antiplatelet antibodies is neither diagnostic nor reliable. Autoimmune neutropenia (AIN) and pure red cell aplasia (PRCA) are very rare complications of CLL and like other autoimmune complications of CLL may occur at any clinical stage. It is believed that most case reports of AIN and PRCA in CLL actually belong to large granular lymphocytic leukemia (LGL). Non-hematologic autoimmune complications of CLL including cold agglutinin disease (CAD), paraneoplastic pemphigus (PNP), acquired angioedema, and anti-myelin associated globulin are rare.Before starting any treatment, clinicians should distinguish between autoimmune cytopenias and massive bone marrow infiltration since autoimmune complications of CLL are not necessarily equal to advanced disease with poor prognosis. According to IWCLL guideline, steroids are the mainstay of treatment of simple autoimmunity. Intravenous immunoglobulin (IVIg), cyclosporine, and rituximab are used in complex, steroid refractory cases. Monotherapy with purine analogues and alkylating agents should be avoided as they may increase CLL associated autoimmune complications.

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Rituximab therapy in a patient with autoimmune hemolytic anemia and immune thrombocytopenia associated with chronic lymphocytic leukemia

Cited by 2 publications

References 23 publications

Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

Chronic lymphocytic leukemia‐associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients

Autoimmune Cytopenias in Chronic Lymphocytic Leukemia, Facts and Myths

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