Orthotopic Liver Transplantation After Successful Treatment With Anti-CD20 Monoclonal Antibody (Rituximab) for Severe Steroid-Resistant Autoimmune Hemolytic Anemia: A Case Report

Warm autoimmune hemolytic anemia (WAIHA) is one of four clinical types of autoimmune hemolytic anemia (AIHA), with the characteristics of autoantibodies maximally active at body temperature. It produces a variable anemia—sometimes mild and sometimes severe. With respect to the absence or presence of an underlying condition, WAIHA is either idiopathic (primary) or secondary, which determines the treatment strategies in practice. Conventional treatments include immune suppression with corticosteroids and, in some cases, splenectomy. In recent years, the number of clinical studies with monoclonal antibodies and immunosuppressants in the treatment of WAIHA increased as the knowledge of autoimmunity mechanisms extended. This thread of developing new tools of treating WAIHA is well exemplified with the success in using anti-CD20 monoclonal antibody, Rituximab. Following this success, other treatment methods based on the immune mechanisms of WAIHA have emerged. We reviewed these newly developed immunotherapy treatments here in order to provide the clinicians with more options in selecting the best therapy for patients with WAIHA, hoping to stimulate researchers to find more novel immunotherapy strategies.

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Successful treatment of mixed-type autoimmune hemolytic anemia with rituximab in a child following liver transplantation

Pediatric Transplantation ◽

10.1111/j.1399-3046.2009.01128.x ◽

2010 ◽

Vol 14 (3) ◽

pp. E20-E25 ◽

Cited By ~ 5

Author(s):

Wolfram Haller ◽

Jonathan Hind ◽

Sue Height ◽

Ragai Mitry ◽

Anil Dhawan

Keyword(s):

Liver Transplantation ◽

Hemolytic Anemia ◽

Successful Treatment ◽

Autoimmune Hemolytic Anemia ◽

Mixed Type

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Anti-CD20 Monoclonal Antibody in the Treatment of Refractory Autoimmune Cytopenias in Adults.

Blood ◽

10.1182/blood.v104.11.2717.2717 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2717-2717

Author(s):

Santhosh Narat ◽

Jagdish Gandla ◽

Atul B. Mehta

Keyword(s):

Monoclonal Antibody ◽

Median Time ◽

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Complete Response ◽

Maximum Response ◽

Maximal Response ◽

Effective Treatment Option ◽

Number Of Patients ◽

Anti Cd20

Abstract Anti-CD20 monoclonal antibody (rituximab) has been used in autoimmune cytopenia with variable success.We report 13 patients with chronic refractory autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP) who each received 4 cycles of rituximab 375mg/m2 weekly. All 8 AIHA patients (6 idiopathic,2 secondary to a lymphoproliferative disorder, 5 splenectomised) had warm antibody type. Response was seen in 4(50%) of 8 patients (3 CR,1PR) and 3 patients remain in CR at 5,7,14 months post-therapy. Median time to maximum response (TMR) in responders was 9 weeks(range 6 – 18 weeks). In 5 ITP patients (4 splenectomised), 4(80%) responded (3CR) and one continues in CR 50 weeks after completion of rituximab treatment Median time to maximum response was 4 weeks (range 4 – 12 weeks). No pre-treatment clinical or laboratory parameters that predict response could be identifird in the AIHA or ITP groups.Our data indicate that rituximab is a relatively safe and effective treatment option in patients with refractory autoimmune hemolytic anemia and thrombocytopenia. Table 1 Number of patients Mean age (Years) Sex Overall response Complete response No response Time to maximal response AIHA 8 47.75 (26– 73) 3M:4F 4 (50%) 3 (37.5%) 4 (50%) 9 weeks ITP 5 58.6 (28–89) 4M:1F 5 (80%) 3 (60%) 2 (40%) 4 weeks

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Use of Rituximab in Autoimmune Hemolytic Anemia Associated with Non-Hodgkin Lymphomas

Advances in Hematology ◽

10.1155/2011/960137 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Claudio Fozza ◽

Maurizio Longinotti

Keyword(s):

Monoclonal Antibody ◽

Chronic Lymphocytic Leukemia ◽

Hemolytic Anemia ◽

Antibody Production ◽

Autoimmune Hemolytic Anemia ◽

Therapeutic Approach ◽

Lymphoproliferative Disorders ◽

Lymphocytic Leukemia ◽

Pathogenetic Mechanism ◽

Anti Cd20

The association between non-Hodgkin lymphomas and autoimmune disorders is a well-known event. Also autoimmune hemolytic anemia (AHA), although much more frequent in patients with chronic lymphocytic leukemia (CLL), has been described in this group of patients. In recent years, among the more traditional therapeutic options, rituximab, an anti-CD20 monoclonal antibody, has shown interesting results in the treatment of primary AHA. Although this drug has been frequently used for AHA in patients with CLL, much less data are available on its use in NHL patients. However, considering that the main pathogenetic mechanism of AHA in course of lymphoproliferative disorders seems to be an antibody production directly or indirectly mediated by the neoplastic clone, this monoclonal antibody represents an ideal therapeutic approach. In this paper we will briefly describe some biological and clinical features of NHL-patients with AHA. We will then analyze some studies focusing on rituximab in primary AHA, finally reviewing the available literature on the use of this drug in NHL related AHA.

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