Rituximab for warm-type idiopathic autoimmune hemolytic anemia: A retrospective study of 11 adult patients

Giovanni D'Arena, Catello Califano, Mario Annunziata, Alfredo Tartarone, Silvana Capalbo, Oreste Villani, Giovanni Amendola, Giuseppe Pietrantuono, Felicetto Ferrara, Antonio Pinto, Pellegrino Musto, Alfonso Maria D'Arco, Nicola Cascavilla

Research output: Contribution to journalArticlepeer-review

Abstract

Warm-type idiopathic autoimmune hemolytic anemia (AIHA) is a relatively common hematologic disorder resulting from autoantibody production against red blood cells. Steroids represent the first-line therapeutic option, and immunosuppressive agents as well as splenectomy are used for refractory cases. Recently, the anti-CD20 monoclonal antibody rituximab has been shown to control autoimmune hemolysis in patients with refractory chronic disease. We report results from a retrospective analysis of 11 adult patients receiving rituximab for steroid-refractory AIHA of the warm type at a mean age of 55 yr (range 23-81 yr). All patients were given methyl-prednisolone as first-line treatment and some of them also received azathioprine and intravenous high-dose immunoglobulins. One patient underwent splenectomy. All patients were considered refractory to steroids and/or immunosuppressive drugs and all were then given weekly rituximab (375 mg/m2) for four consecutive weeks. An increase in hemoglobin (Hgb) levels in response to rituximab, with a mean increment of 3.3 g/dL (95% CI 2.1-4.4), was observed in all cases. Four patients required packed red cell transfusions before starting rituximab and all became transfusion-free. At a mean follow-up of 604 d (range 30-2884 d) since the treatment of AIHA with rituximab, all patients are alive, eight (73%) of them in complete remission (CR) and three (27%) in partial remission (PR). A moderate hemolysis still persisted in six (54%) patients. In conclusion, our experience clearly demonstrates that anti-CD20 monoclonal antibody rituximab is an effective and safe alternative treatment option for idiopathic AIHA, in particular, for steroid-refractory disease.

Original languageEnglish
Pages (from-to)53-58
Number of pages6
JournalEuropean Journal of Haematology
Volume79
Issue number1
DOIs
Publication statusPublished - Jul 2007

Keywords

  • Autoimmune hemolytic anemia
  • Monoclonal antibody
  • Rituximab

ASJC Scopus subject areas

  • Hematology

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