Clinical characteristics and long-term outcomes of warm-type autoimmune hemolytic anemia

Rattarittamrong, Ekarat; Eiamprapai, Prot; Tantiworawit, Adisak; Rattanathammethee, Thanawat; Hantrakool, Sasinee; Chai‐Adisaksopha, Chatree; Norasetthada, Lalita

doi:10.1080/10245332.2016.1138621

Cited by 26 publications

(42 citation statements)

References 21 publications

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“…These results are similar to the response rates achieved in other centers, where more than 80% of wAIHA cases responded to steroids [81516]. We also found that patients diagnosed with secondary wAIHA responded faster than those with primary wAIHA (18 vs. 37 days, P =0.05).…”

Section: Discussionsupporting

confidence: 90%

“…Nevertheless, probably due to the underlying autoimmune disorders, secondary wAIHA patients relapsed more frequently than primary wAIHA patients that the primary wAIHA patients had a median DFS of 51 weeks versus 28 weeks in patients with secondary wAIHA ( P =0.018). It is important to state that other studies have found no statistically significant differences in terms of DFS between primary and secondary wAIHA [1621]. Among the causes of secondary wAIHA, we only found a statistically significant difference in TB levels at diagnosis in the patients with autoimmune-related wAIHA.…”

Section: Discussioncontrasting

confidence: 63%

“…This gender predilection could be attributed to the fact that women are more susceptible to autoimmune diseases. The median age at diagnosis was 36 years, which is slower than the previous reports (i.e., 50 yrs) [1617]. This discrepancy can be explained by the fact that our institution is a referral center for SLE and APLS, which are diseases that mostly affect women of childbearing age.…”

Section: Discussionmentioning

confidence: 72%

“…Few studies have compared the clinical and biochemical differences between primary and secondary wAIHA [61619]. In our population, the only statistically significant difference encountered between these two groups was the correlation of a mixed pattern with secondary wAIHA ( P <0.001).…”

Section: Discussionmentioning

confidence: 74%

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Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

et al. 2017

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BackgroundAutoimmune hemolytic anemia (AIHA) is characterized by an autoimmune-mediated destruction of red blood cells. Warm AIHA (wAIHA) represents 60% of AIHA cases and is associated with the positive detection of IgG and C3d in the direct antiglobulin test (DAT). This study aimed to assess the clinical and laboratorial differences between primary and secondary wAIHA patients from a referral center in Mexico City.MethodsAll patients diagnosed with wAIHA in our institution from January 1992 to December 2015 were included and received corticosteroids as the first-line treatment. We analyzed the response to the first-line treatment, relapse-free survival, and time to splenectomy.ResultsEighty-nine patients were included. Secondary wAIHA represented 55.1% of the cases. At diagnosis, secondary wAIHA patients showed a DAT mixed pattern more frequently than primary wAIHA patients (36.7 vs. 17.5%, P<0.001). In the survival analysis, patients with secondary wAIHA had a lower time to response (18 vs. 37 days, P=0.05), median disease-free survival (28.51 vs. 50.95 weeks, P=0.018), and time to splenectomy (43.5 vs. 61 wks, P=0.029) than those with primary wAIHA. Due to economic constraints, rituximab was considered as the third-line treatment in only two patients.ConclusionSecondary wAIHA may benefit from a longer low-dose steroid maintenance period mainly due to its shorter time to relapse and time to splenectomy than primary wAIHA.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 74%

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Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

et al. 2017

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“…Relapse occurred in approximately 50% of patients with primary AIHA, but the relapse rate for AIHA posttransplants had rarely been reported. 26,27 In our study, the relapse rate was higher in the Whether AIHA contributes to increase TRM has not yet been defined. 7,12,18 Daikeler et al suggested that AIHA was not attributable to TRM.…”

Section: Discussionmentioning

confidence: 60%

Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in adults: A southern China multicenter experience

et al. 2019

Cancer Medicine

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To investigate the incidence and risk factors as well as prognosis of autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (allo‐HSCT), a total of 1377 adult hematological malignancies at three institutions were enrolled in this study. The 3‐year cumulative incidence of AIHA was 2.2 ± 0.4%. Multivariate analysis showed that haploidentical donors (HRDs) and chronic graft vs host disease (cGVHD) were the independent risk factors for AIHA. Patients with AIHA treated initially with corticosteroids combined with cyclosporine A (CsA) had a higher complete response rate than those with corticosteroids monotherapy (66.7% vs 11.1%; P = .013). The 3‐year cumulative incidence of malignant diseases relapse was 4.4 ± 4.3% and 28.0 ± 1.3% (P = .013), treatment‐related mortality (TRM) was 8.9 ± 6.3% and 17.4 ± 1.2% (P = .431), disease‐free survival (DFS) was 56.1 ± 1.5% and 86.7 ± 7.2% (P = .011), and overall survival (OS) was 86.3 ± 7.4% and 64.1 ± 1.5% (P = .054), respectively, in the patients with AIHA and those without AIHA. Our results indicate that HRDs and cGVHD are risk factors for AIHA and corticosteroids combined with CsA are superior to corticosteroids as initial treatment for AIHA. Autoimmune hemolytic anemia does not contribute to increase TRM and could reduce the malignant diseases relapse and increase DFS.

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Clinical Features and Treatment Outcomes of Warm Autoimmune Hemolytic Anemia: A Retrospective Analysis of 60 Turkish Patients

Yilmaz

Kiper

Koç

et al. 2019

Indian J Hematol Blood Transfus

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We aimed to analyze 10-year experience of WAIHA patients at a single referral center in Turkey. Clinical data, survival outcome of sixty patients who were diagnosed with WAIHA were retrospectively analyzed. All the patients were direct antiglobulin test (DAT) positive. In 21 (30%) patients, IgG plus C3d DAT positivity was documented. 16 patients were secondary WAIHA and most common underlying causes were lymphoproliferative diseases (5 patients) and connective tissue disease (8 patients). Corticosteroids were first choice as a first line therapy with 54.5% CR and 40.2% PR rates. 43.3% of the patients relapsed after a median 12 months. In relapsed patients, rituximab and splenectomy achieved 85% overall response rates. The median OS was not reached. The median DFS was 40 months (95% CI, 19.6-60.4). OS and DFS at 36 months were 89.6% and 51.1%, respectively. DFS at 36 months was lower in patients with IgG plus C3d positive DAT than patients with only positive Ig G DAT (36 vs. 54%) but this difference could not reach statistical significance (p = 0.23). WAIHA was a rare disease with a good prognosis. Corticosteroids were the first option and splenectomy and rituximab received good responses in relapsed patients. Attention should be paid especially in patients with IgG plus C3d DAT positivity since lower DFS were reported. Characteristics and pathogenesis of patients with IgG plus C3d DAT positivity was still an obscure.

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Clinical characteristics and long-term outcomes of warm-type autoimmune hemolytic anemia

Cited by 26 publications

References 21 publications

Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in adults: A southern China multicenter experience

Clinical Features and Treatment Outcomes of Warm Autoimmune Hemolytic Anemia: A Retrospective Analysis of 60 Turkish Patients

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