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

Pamuk, Gülsüm Emel; Turgut, Burhan; Demir, Muzaffer; Tezcan, Fatma; Vural, Özden

doi:10.1002/ajh.20671

Cited by 13 publications

(8 citation statements)

References 18 publications

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“…At doses of 375 mg/m 2 weekly for four weeks, rituximab has been shown to be effective and well-tolerated, with objective responses seen in approximately 70%–100% of patients. 35,36,37 A similar approach can be used in steroid refractory warm antibody mediated AIHA in CLL. Use of lower doses of rituximab at 100 mg/m 2 for 4 weekly infusions in conjunction with steroids has been studied only in primary AIHA, although a similar strategy could be used in CLL patients with AIHA.…”

Section: Autoimmune Hemolytic Anemiamentioning

confidence: 99%

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Tsang

2017

Curr Hematol Malig Rep

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Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune complications such as autoimmune hemolytic anemia, immune thrombocytopenia, pure red cell aplasia and autoimmune granulocytopenia. It is critical to diagnose cytopenias from these secondary complications of CLL accurately, since prognosis and therapy are substantially different from patients who have cytopenias due to extensive bone marrow infiltration by CLL. The pathogenesis of autoimmune cytopenias in CLL is complex; and involves antigen presentation by CLL cells to polyclonal B-cells resulting in production of autoantibody and alteration of the T-cell milieu tilting the balance in favor of an autoimmune response. Traditional therapy of autoimmune complications in CLL consists of immunosuppression with corticosteroids and/or anti-CD20 monoclonal antibodies. In patients who have a suboptimal response, treating the underlying CLL is generally effective in ameliorating secondary cytopenias. Although novel oral therapies such as ibrutinib, idelalisib and venetoclax have been shown to be extremely effective in the management of CLL; prospective data from larger numbers of patients with longer follow-up are needed prior to recommending their routine use in the management of autoimmune cytopenias in CLL.

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Section: Autoimmune Hemolytic Anemiamentioning

confidence: 99%

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Tsang

2017

Curr Hematol Malig Rep

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“…71,82 There are case reports of the use of combinations of the anti-CD20 monoclonal antibody rituximab with or without immunosuppression with good effect. [83][84][85][86][87] The anti-CD52 monoclonal antibody alemtuzumab has also been successfully used. [88][89][90] Intravenous immunoglobulin can be useful where a rapid response is needed (e.g.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Chronic lymphocytic leukemia and autoimmunity: a systematic review

Hodgson¹,

Ferrer²,

Montserrat³

et al. 2011

Haematologica

120

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“…The anti‐CD20 monoclonal antibody rituximab has established short‐term efficacy in treating AIHA and ITP, as well as anti‐CLL activity either as a single agent or in combination with immunosuppressive agents (Chemnitz et al , 2002; Pamuk et al , 2006; Garvey, 2008; Gentile et al , 2008; D’Arena et al , 2010). Rituximab has been used successfully to treat patients with CLL and PRCA, both arising de novo and following therapy with fludarabine (Ghazal, 2002; Narra et al , 2006).…”

Section: Treatmentmentioning

confidence: 99%

Autoimmune cytopenia in chronic lymphocytic leukaemia: diagnosis and treatment

Hodgson¹,

Ferrer²,

Pereira

et al. 2011

Br J Haematol

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Summary Autoimmune cytopenia, especially autoimmune haemolytic anaemia (AIHA), appears in 5–10% of patients with chronic lymphocytic leukaemia (CLL). In these patients, the prognosis is not as poor as in those cases in which the cytopenia is due to a massive bone marrow infiltration by the disease, and their treatment requires special considerations. For these reasons, the diagnosis of autoimmune cytopenia should be entertained in any patient with CLL presenting with cytopenia. In patients with autoimmune cytopenia and CLL, treatment is as for idiopathic autoimmune cytopenia, with most patients responding to corticosteroids. For patients not responding to corticosteroids, splenectomy is a reasonable treatment choice. Monoclonal antibodies and thrombopoietin analogues have shown enough activity to support their use, especially within clinical studies, in selected cases not responding to corticosteroids and before splenectomy. In patients with resistant immune cytopenia, the most effective treatment is that of the underlying CLL. Fear of fludarabine‐associated AIHA is no longer appropriate in the age of chemo‐immunotherapy. Finally, prospective studies are required to better identify the optimal therapy for these patients.

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

Cited by 13 publications

References 18 publications

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia and autoimmunity: a systematic review

Autoimmune cytopenia in chronic lymphocytic leukaemia: diagnosis and treatment

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