Rituximab Use in Warm and Cold Autoimmune Hemolytic Anemia

Abstract

Autoimmune hemolytic anemia is a rare condition characterized by destruction of red blood cells with and without involvement of complement. It is associated with significant morbidity and mortality. In warm autoimmune hemolytic anemia, less than 50% of patients remain in long-term remission following initial steroid therapy and subsequent therapies are required. Cold agglutinin disease is a clonal hematologic disorder that requires therapy in the majority of patients and responds poorly to steroids and alkylators. Rituximab has a favorable toxicity profile and has demonstrated efficacy in autoimmune hemolytic anemia in first-line as well as relapsed settings. Rituximab is the preferred therapy for steroid refractory warm autoimmune hemolytic anemia (wAIHA) and as part of the first- and second-line treatment of cold agglutinin disease. This article reviews the mechanism of action of rituximab and the current literature on its role in the management of primary and secondary warm autoimmune hemolytic anemia and cold agglutinin disease.

The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket?

“…Rituximab at a conventional (375 mg/m 2 at 1-week interval for 4 weeks) or low dose (100 mg fixed dose at the same schedule) is currently recommended in the second line in primary wAIHA ( 1 , 51 , 55 , 56 ). However, there are no published data to support repeated use of rituximab in wAIHA patients who have received this monoclonal antibody and subsequently relapsed.…”

Anemia hemolítica autoinmune: una visión actual desde la inmunopatogenia hasta el tratamiento

“…Otra combinación es rituximab con bendamustina un agente alquilante antitumoral, con una respuesta terapéutica en el 71 % de los pacientes, de los cuales 40 % logró respuesta completa. Esta combinación puede ser considerada como terapia de primera línea en pacientes con EAF severa (55,56).…”

Secondary Dysgammaglobulinemia in Children with Hematological Malignancies Treated with Targeted Therapies

“…The FDA has approved rituximab for patients with NHL and CLL [22]. In addition, rituximab has shown favorable outcomes off-label in children with immune thrombocytopenia, autoimmune hemolytic anemia, and autoimmune diseases as second-or third-line treatment after failure of conventional therapy with corticosteroids and/or intravenous immunoglobulin (IVIG) [50][51][52][53]. Despite the wide use of rituximab in pediatric patients with B-cell malignancies, knowledge on the impact of its use on the incidence of bacterial, viral, and fungal infections is limited.…”