Successful treatment of pure red cell aplasia with rituximab in patients with chronic lymphocytic leukemia

Ghazal, Hassan

doi:10.1182/blood.v99.3.1092

Cited by 90 publications

(62 citation statements)

References 10 publications

(10 reference statements)

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“…As current treatment of autoimmune disease adds considerably to patient morbidity and mortality, lesstoxic treatments are required. Targeted therapy against the normal B lymphocytes producing pathogenic autoantibodies may be effective, as suggested by recent reports of the successful use of rituximab to treat resistant hemolytic anemia [25,26] and PRBCA [27] in patients with CLL. While splenectomy was ineffective in one of our patients with AIHA, this option needs to be considered in patients not tolerating prolonged corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

et al. 2003

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Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is characterized by an acquired immune defect that can cause autoimmune complications, including anemia and thrombocytopenia. We conducted an observational study of the epidemiology, clinical presentation and significance of autoimmune complications of CLL/SLL in 132 patients from a large population (>45,000 veterans), in which at least 90% of patients with CLL/SLL have been previously identified. Over a period of 12.5 years, 12 patients (9.1%) had autoimmune complications; of these, 6 (4.5%) had autoimmune hemolytic anemia (AIHA), 5 (3.8%) had immune thrombocytopenia (ITP), and 1 (0.8%) had pure red blood cell aplasia (PRBA). All 6 cases of AIHA had a positive direct immunoglobulin test for IgG and C3d. In 6 patients, CLL/SLL was an incidental finding at the time of presentation with autoimmune cytopenia. Nine out of 10 patients responded to immunosuppressive therapy, which was complicated by serious infection in 7 cases, one of which was fatal. The major cause of mortality in patients with autoimmune complications of CLL/SLL was secondary malignancy. Survival of patients with immune cytopenia was not significantly different from CLL/SLL patients without immune cytopenia. Among patients with anemia or thrombocytopenia, mortality was significantly higher in those with bone marrow failure compared to an autoimmune etiology. We show that in a non-referred population with a high incidence of CLL/SLL, autoimmune cytopenia can occur early in the natural history of the disease. These data suggest that the Rai and Binet classifications for CLL need to be modified for patients with autoimmune cytopenia. Am.

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Section: Discussionmentioning

confidence: 99%

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

et al. 2003

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“…Response to steroids in PRCA can be monitored by assessing the reticulocyte count. Rituximab has been successful in the treatment of PRCA 41 but another study noted that it was less effective in refractory autoimmune neutropenia. 42 Nonhematological autoimmune phenomena Autoimmune conditions affecting nonhematological tissues are rare but well-described, and in some instances have been precipitated by therapy ( Table 3).…”

Section: Pure Red Cell Aplasia and Autoimmune Neutropeniamentioning

confidence: 99%

Disease-Specific Complications of Chronic Lymphocytic Leukemia

Dearden¹

2008

Hematology

150

131

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“…Both patients responded dramatically to rituximab therapy in a short period of time and became transfusion-independent [15]. Rituximab was used later by others for the treatment of PRCA in CLL, and the results were promising [16,17].…”

Section: Discussionmentioning

confidence: 94%

“…Ghazal [15] reported the first two patients for whom rituximab treatment for PRCA in CLL was successful. Both patients responded dramatically to rituximab therapy in a short period of time and became transfusion-independent [15].…”

Section: Discussionmentioning

confidence: 99%

The successful treatment of refractory autoimmune hemolytic anemia with rituximab in a patient with chronic lymphocytic leukemia

et al. 2006

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The most frequent autoimmune complication in chronic lymphocytic leukemia (CLL) is autoimmune hemolytic anemia (AIHA). There are various treatment modalities; however, there is not much experience with the use of the chimeric anti-CD20 monoclonal antibody rituximab in the autoimmune complications of CLL. Here, we present our patient with CLL and AIHA whose AIHA was unresponsive to various treatment modalities. The administration of 375 mg/m 2 /day rituximab weekly for four cycles halted hemolysis and resulted in resolution of the patient's anemia. One year after therapy, the patient is well with a normal blood count. Rituximab might be preferred over other treatment modalities in the autoimmune complications of CLL because it is effective and has fewer side effects than other therapies. Am. J.

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Successful treatment of pure red cell aplasia with rituximab in patients with chronic lymphocytic leukemia

Cited by 90 publications

References 10 publications

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

Disease-Specific Complications of Chronic Lymphocytic Leukemia

The successful treatment of refractory autoimmune hemolytic anemia with rituximab in a patient with chronic lymphocytic leukemia

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