The role of rituximab in adults with warm antibody autoimmune hemolytic anemia

Dierickx, Daan; Kentos, Alain; Delannoy, André

doi:10.1182/blood-2015-01-588392

Cited by 59 publications

(27 citation statements)

References 55 publications

(82 reference statements)

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“…Furthermore, it has to be taken into account that treatment effect can take several weeks to months to occur. For rituximab, the median time to response is 4‐6 weeks . Nevertheless, pressed by the difficult clinical situation, we waited for only two weeks after rituximab before starting bortezomib.…”

Section: Discussionmentioning

confidence: 99%

Bortezomib for autoimmune hemolytic anemia after intestinal transplantation

Knops

Emonds

Herman

et al. 2020

Pediatric Transplantation

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AIHA is rare in the general population and associated with a mortality of 8%. In contrast, AIHA occurs in up to 12.2% of cases after intestinal transplantation and is associated with mortality up to 50%. Treatment entails a "step-up" approach including corticosteroids, IvIg, plasmapheresis, and rituximab. However, AIHA after transplantation often is refractory to this strategy, contributing to a poor outcome. We describe a child with microvillous inclusion disease who developed AIHA 1 year after multivisceral transplantation that was refractory to standard therapy and was subsequently treated with bortezomib.We observed remission of AIHA within 1 week after the start of bortezomib. Bortezomib was associated with transient diarrhea, leucopenia, and elevated liver enzymes. Three years later, he remains in remission without important complications. Published data on bortezomib for autoimmune cytopenias outside SOT are discussed. This is the first report to support bortezomib as an important therapeutic alternative for AIHA after SOT. The occurrence and treatment of AIHA after SOT, and specifically intestinal transplantation, should be the subject of future registry studies to collect additional experience and explore the optimal therapeutic approach.

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Section: Discussionmentioning

confidence: 99%

Bortezomib for autoimmune hemolytic anemia after intestinal transplantation

Knops

Emonds

Herman

et al. 2020

Pediatric Transplantation

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“…24,30,31 Patients without an underlying autoimmune disease or hematologic malignancy are twice as likely to respond as those with such conditions (82% vs 19% complete response). 32 Although rituximab has increasingly superseded splenectomy in recent retrospective studies and may be primary second line for some centers, 33 we still consider splenectomy as the primary second-line option in idiopathic AIHA. In one study of 52 patients with AIHA, 64% were in unmaintained remission after a mean follow-up of 33 months.…”

Section: What Is the Value Of Splenectomy?mentioning

confidence: 99%

How I treat autoimmune hemolytic anemia

Go¹,

Winters

Kay³

2017

Blood

151

113

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Autoimmune hemolytic anemia (AIHA) is an uncommon entity that presents diagnostic, prognostic, and therapeutic dilemmas despite being a well-recognized entity for over 150 years. This is because of significant differences in the rates of hemolysis and associated diseases and because there is considerable clinical heterogeneity. In addition, there is a lack of clinical trials required to refine and update standardized and evidence-based therapeutic approaches. To aid the clinician in AIHA management, we present four vignettes that represent and highlight distinct clinical presentations with separate diagnostic and therapeutic pathways that we use in our clinical practice setting. We also review the parameters present in diagnostic testing that allow for prognostic insight and present algorithms for both diagnosis and treatment of the AIHA patient in diverse situations. This is done in the hope that this review may offer guidance in regard to personalized therapy recommendations. A section is included for the diagnosis of suspected AIHA with negative test results, a relatively infrequent but challenging situation, in order to assist in the overall evaluation spectrum for these patients. (Blood. 2017; 129(22):2971-2979

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“…The overall response (OR) rate with rituximab is 79% with a complete response (CR) rate of 42% for patients with WAIHA [8]. Sustained responses (SR) of 3 years have been observed in up to 30% of patients [9-11].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of the Combination of Rituximab, Cyclophosphamide and Dexamethasone for the Treatment of Relapsed/Refractory Warm Antibody Autoimmune Hemolytic Anemia

et al. 2019

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The combination of rituximab, cyclophosphamide, and dexamethasone (RCD) is highly effective in the treatment of warm autoimmune hemolytic anemia (WAIHA) associated with chronic lymphocytic leukemia (CLL). We treated a cohort of patients with relapsed/refractory WAIHA, without CLL, with RCD. The primary objective was to evaluate the overall response (OR) of RCD therapy. Complete response (CR) was defined as a hemoglobin (Hgb) ≥12 g/dL. Partial response (PR) was defined as Hgb 10–11.9 g/dL or ≥2 g/dL increase in Hgb. Sustained response was defined as Hgb ≥10 g/dL with no treatment changes. A total of 16 patients with relapsed/refractory WAIHA received RCD (7 primary WAIHA, 9 secondary WAIHA) for a median of 4 cycles (range: 2–6). The median pretreatment Hgb was 10.0 g/dL (range: 4.3–12.2). The median best Hgb achieved was 12.5 g/dL (range: 10.6–15.1) with a median of 2 cycles until best Hgb response. The OR was 94% (11 CR, 4 PR). Two immunocompromised patients were admitted for infections during RCD treatment. There were no deaths during the treatment or follow-up period. Following a response to RCD, 4 patients received noncorticosteroid immune modulation therapy and 4 patients continued on corticosteroid therapy. Seven patients received no additional treatment.

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The role of rituximab in adults with warm antibody autoimmune hemolytic anemia

Cited by 59 publications

References 55 publications

Bortezomib for autoimmune hemolytic anemia after intestinal transplantation

Bortezomib for autoimmune hemolytic anemia after intestinal transplantation

How I treat autoimmune hemolytic anemia

A Retrospective Study of the Combination of Rituximab, Cyclophosphamide and Dexamethasone for the Treatment of Relapsed/Refractory Warm Antibody Autoimmune Hemolytic Anemia

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