Rituximab therapy for chronic lymphocytic leukemia-association autoimmune hemolytic anemia

Giovanni D'Arena, Luca Laurenti, Silvana Capalbo, Alfonso Maria D'Arco, Rosaria De Filippi, Gianpaolo Marcacci, Nicola Di Renzo, Sergio Storti, Catello Califano, Maria Luigia Vigliotti, Michela Tarnani, Felicetto Ferrara, Antonio Pinto

Research output: Contribution to journalArticle

Abstract

Autoimmune hemolytic anemia (AIHA) is a well-known complication of chronic lymphocytic leukemia (CLL). In recent years the anti-CD20 monoclonal antibody rituximab has been used for the therapy of steroid-refractory AIHA and autoimmune thrombocytopenia, either idiopathic or in association with CLL. We report the results of rituximab treatment for 14 patients suffering from CLL-associated AIHA. They developed a direct antiglobulin test positive AIHA at a mean time of 47 months (range 0-135 months) from the diagnosis of CLL. In 3 cases AIHA was diagnosed at the same time as CLL. Only 1 patient had fludarabine-related AIHA. All patients received steroids as first-line treatment. At a mean time of 46 days (range 1-210 days) from the diagnosis of AIHA all patients received rituximab at a dosage of 375 mg/m2/weekly for 4 weeks. All patients except 3 (2 died of cardiac failure or sepsis soon after the third cycle and 1 HCV-positive patient experienced a rise in serum amino transferases) completed the scheduled four programmed cycles. First injection side effects of rituximab were minimal. All but 2 patients showed an increase in hemoglobin levels in response to rituximab (mean value 3.6 g/dl; range 0.7-10 g/dl) and a reduction in the absolute lymphocyte count and lymph nodes and spleen volume. Nine patients required packed red cell transfusions before starting rituximab; 5 no longer needed transfusions just after the second cycle and another patient after the fourth cycle. Three patients (22%) were considered to fully respond and 7 (50%) only responded partially. At a mean follow-up of 17 months, 8 patients were still alive, 6 of them transfusion-free. Our results prove that the anti-CD20 monoclonal antibody is an effective and well-tolerated alternative treatment for CLL-associ-ated AIHA.

Original languageEnglish
Pages (from-to)598-602
Number of pages5
JournalAmerican Journal of Hematology
Volume81
Issue number8
DOIs
Publication statusPublished - Aug 2006

Keywords

  • Autoimmune hemolytic anemia
  • Chronic lymphocytic leukemia
  • Rituximab

ASJC Scopus subject areas

  • Hematology

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    D'Arena, G., Laurenti, L., Capalbo, S., D'Arco, A. M., De Filippi, R., Marcacci, G., Renzo, N. D., Storti, S., Califano, C., Vigliotti, M. L., Tarnani, M., Ferrara, F., & Pinto, A. (2006). Rituximab therapy for chronic lymphocytic leukemia-association autoimmune hemolytic anemia. American Journal of Hematology, 81(8), 598-602. https://doi.org/10.1002/ajh.20665