A multi‐centre retrospective study of rituximab use in the treatment of relapsed or resistant warm autoimmune haemolytic anaemia

Abstract

SummaryThis retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg/m 2 weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70Á6% (24/34) with 26Á5% (9/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87Á5% (21/24) and 3 months in 12Á5% (3/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12/24) relapsed during follow up with a median time to next treatment of 16Á5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg/m2 weekly for four weeks at relapse and responded.There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.

Treatment of autoimmune hemolytic anemias

“…35,38 In a recent multicenter retrospective study, the time to response was one month post-initiation of rituximab in 87.5% and three months in 12.5% of patients. 39 It is worth remembering that rituximab re-treatment may be effective 35,39,40 and some patients responded to re-treatment more than once. 34,35 Rituximab has also been found to be effective in Evans syndrome with a reported overall response of 83% (66% complete).…”

Autoimmune Hemolytic Anemia:Focusing on Therapy According to Classification

“…Another study by Bussone, et al, demonstrated a 93% of overall initial response to rituximab therapy with standard doses [44]. Relapse is unavoidable during follow up periods but retreatment with rituximab is effective in these patients [44,45]. Since patients may benefit from second course of rituximab, intermittent or a maintenance therapy should be considered.…”

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

“…2,23,[25][26][27] In 4 studies, responses in wAIHA and cold agglutinin disease (CAD) were compared and were found superior in wAIHA in 3 studies, 2,23,25 whereas no difference in response rate was observed in the study of Peñalver et al In the GIMEMA study, this difference was noted in patients given low-dose rituximab, whereas no significant difference in response rate was found after treatment with a conventional dose of rituximab. 2 In addition, in the same study, an increased response rate was associated with young age and with a shorter interval between treatment and diagnosis only in patients given low-dose rituximab.…”

“…Recent studies with longer follow-up show that responses up to 3 years are sustained in a proportion of patients (up to 30%). 26,43 Whether some patients can be considered cured after rituximab administration is not clear, given the lack of long-term follow-up in most published series. Maintenance therapy with rituximab aiming to prolong duration of response has not been investigated in this setting.…”

“…Of 34 relapsing patients reported outside single case reports, 32 responded again to rituximab. 26,32,36,37,54 Of note, reminiscent of thrombopoietin agonists in immune thrombocytopenic purpura, some patients seem to respond to erythropoietin. In the GIMEMA study, 13 of 14 patients with AIHA responded to treatment with erythropoietin but were given concomitant various therapies, which precludes any convincing conclusion.…”