Refractory autoimmune haemolytic anaemia following allogenic haematopoietic stem cell transplantation: successful treatment of rituximab

Abstract

Objective To investigate the effectiveness and safety of rituximab in treating autoimmune haemolytic anaemia (AIHA) after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Methods Patients with refractory AIHA following allo-HSCT were treated once-weekly with rituximab 375 mg/m2 for a total of four doses. In an animal study, recipient CB6F1 mice were conditioned with busulfan/fludarabine and transplanted with splenocytes and T-cell-depleted bone marrow from C57Bl/6 mice. In this animal model, anti-CD20 monoclonal antibody (mAb) was evaluated to see if it could prevent graft versus host disease (GVHD). GVHD was monitored by body weight loss, GVHD clinical scores and the survival of each group of mice. Histopathological analyses of the skin, intestine, liver and lung were used to analyse the severity of GVHD. Results After rituximab therapy, refractory AIHA was resolved in all four patients as shown by increased haemoglobin levels. B-cell proportions were reduced with a relative increase of the proportions of T-cells following rituximab treatment. None of the four patients experienced chronic GVHD. In the animal model, anti-CD20 mAb treatment reduced GVHD. Conclusions Rituximab therapy deserves consideration for the treatment of post-HSCT patients with refractory AIHA. Further studies are needed to define the therapeutic role of this anti-CD20 mAb.

Outcome of autoimmune cytopenia after hematopoietic cell transplantation in primary immunodeficiency

“…Impaired B-lymphocyte immunity has been reported in up to 56% of patients who received rituximab, and some of the patients have long-lasting B-lymphocyte dysfunction. [27][28][29] The spectrum of secondary hypogammaglobinemia in nontransplanted patients ranges from mild, with no significant increase in infection rate, to severe with life-threatening infection. 30,31 Factors affecting B-lymphocyte reconstitution postrituximab, which have been reported in nontransplanted patients, include low prerituximab immunoglobulin level, low prerituximab CD19 count, a higher number of rituximab doses, use of other immunosuppressive therapy, older age, underlying disease, coexisting medical illness, or a combination of these factors.…”