Sustained response of refractory chronic lymphocytic leukemia in progression complicated by acute hemolitic anemia to anti-CD20 monoclonal antibody

Iannitto, Emilio; Ammatuna, Emanuele; Marino, C; Cirrincione, Sonia; Greco, Gabriele H.; Mariani, G

doi:10.1182/blood.v99.3.1096a

Cited by 21 publications

(17 citation statements)

References 3 publications

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“…3,6,7,20 More recently, this new agent was described, in preliminary reports, as a possible promising treatment for patients with refractory AIHA. [9][10][11][12][13][14][15][16][17][18]21 However, treatment of a rather limited number of patients was reported, with heterogeneous clinical features and a relatively short follow-up period. Only the study of Quartier et al 9 evaluated the efficacy of rituximab on a relatively homogenous group of 6 children with AIHA.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] The good therapeutic efficacy, coupled with its limited toxicity, consisting primarily of infusion-related events, has led to the recent use of this agent for the treatment of autoimmune disorders, with the aim of interfering with or, at best, abolishing autoantibody production. [9][10][11][12][13][14][15][16][17] Preliminary results of this application appeared encouraging [9][10][11][12][13][14][15][16][17] and prompted us to evaluate, in a prospective multicenter study, the efficacy of rituximab for treatment of children affected by AIHA resistant to conventional immunosuppressive therapy or requiring continuous high-dose steroid treatment.…”

Section: Introductionmentioning

confidence: 99%

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Rituximab for the treatment of refractory autoimmune hemolytic anemia in children

Zecca

Nobili

Ramenghi

et al. 2003

Blood

269

202

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Autoimmune hemolytic anemia (AIHA) in children is sometimes characterized by a severe course, requiring prolonged administration of immunosuppressive therapy. Rituximab is able to cause selective in vivo destruction of B lymphocytes, with abrogation of antibody production. In a prospective study, we have evaluated the use of rituximab for the treatment of AIHA resistant to conventional treatment. Fifteen children with AIHA were given rituximab, 375 mg/m 2 /dose for a median of 3 weekly doses. All patients had previously received 2 or more courses of immunosuppressive therapy; 2 patients had undergone splenectomy. After completing treatment, all children received intravenous immunoglobulin for 6 months. Treatment was well tolerated. With a median follow-up of 13 months, 13 patients (87%) responded, whereas 2 patients did not show any improvement. Median hemoglobin levels increased from 7.7 g/dL to a 2-month posttreatment level of 11.8 g/dL (P < .001). Median absolute reticulocyte counts decreased from 236 to 109 ؋ 10 9 /L (P < .01). An increase in platelet count was observed in patients with concomitant thrombocytopenia (Evans syndrome). Three responder patients had relapse, 7, 8, and 10 months after rituximab infusion, respectively. All 3 children received a second course of rituximab, again achieving disease remission. Our data indicate that rituximab is both safe and effective in reducing or even abolishing hemolysis in children with AIHA and that a sustained response can be achieved in the majority of cases. Disease may recur, but a second treatment course may be successful in controlling the disease. (Blood. 2003; 101:3857-3861)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rituximab for the treatment of refractory autoimmune hemolytic anemia in children

Zecca

Nobili

Ramenghi

et al. 2003

Blood

269

202

View full text Add to dashboard Cite

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“…As current treatment of autoimmune disease adds considerably to patient morbidity and mortality, lesstoxic treatments are required. Targeted therapy against the normal B lymphocytes producing pathogenic autoantibodies may be effective, as suggested by recent reports of the successful use of rituximab to treat resistant hemolytic anemia [25,26] and PRBCA [27] in patients with CLL. While splenectomy was ineffective in one of our patients with AIHA, this option needs to be considered in patients not tolerating prolonged corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

et al. 2003

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Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is characterized by an acquired immune defect that can cause autoimmune complications, including anemia and thrombocytopenia. We conducted an observational study of the epidemiology, clinical presentation and significance of autoimmune complications of CLL/SLL in 132 patients from a large population (>45,000 veterans), in which at least 90% of patients with CLL/SLL have been previously identified. Over a period of 12.5 years, 12 patients (9.1%) had autoimmune complications; of these, 6 (4.5%) had autoimmune hemolytic anemia (AIHA), 5 (3.8%) had immune thrombocytopenia (ITP), and 1 (0.8%) had pure red blood cell aplasia (PRBA). All 6 cases of AIHA had a positive direct immunoglobulin test for IgG and C3d. In 6 patients, CLL/SLL was an incidental finding at the time of presentation with autoimmune cytopenia. Nine out of 10 patients responded to immunosuppressive therapy, which was complicated by serious infection in 7 cases, one of which was fatal. The major cause of mortality in patients with autoimmune complications of CLL/SLL was secondary malignancy. Survival of patients with immune cytopenia was not significantly different from CLL/SLL patients without immune cytopenia. Among patients with anemia or thrombocytopenia, mortality was significantly higher in those with bone marrow failure compared to an autoimmune etiology. We show that in a non-referred population with a high incidence of CLL/SLL, autoimmune cytopenia can occur early in the natural history of the disease. These data suggest that the Rai and Binet classifications for CLL need to be modified for patients with autoimmune cytopenia. Am.

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“…Successful treatment of intractable AIHA in CLL has been reported by other authors [12,13]. Iannitto et al [14] reported on one patient with CLL and AIHA whose AIHA had a rapid response to rituximab and his CLL was in partial remission after 1 year.…”

Section: Discussionmentioning

confidence: 70%

The successful treatment of refractory autoimmune hemolytic anemia with rituximab in a patient with chronic lymphocytic leukemia

et al. 2006

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The most frequent autoimmune complication in chronic lymphocytic leukemia (CLL) is autoimmune hemolytic anemia (AIHA). There are various treatment modalities; however, there is not much experience with the use of the chimeric anti-CD20 monoclonal antibody rituximab in the autoimmune complications of CLL. Here, we present our patient with CLL and AIHA whose AIHA was unresponsive to various treatment modalities. The administration of 375 mg/m 2 /day rituximab weekly for four cycles halted hemolysis and resulted in resolution of the patient's anemia. One year after therapy, the patient is well with a normal blood count. Rituximab might be preferred over other treatment modalities in the autoimmune complications of CLL because it is effective and has fewer side effects than other therapies. Am. J.

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Sustained response of refractory chronic lymphocytic leukemia in progression complicated by acute hemolitic anemia to anti-CD20 monoclonal antibody

Cited by 21 publications

References 3 publications

Rituximab for the treatment of refractory autoimmune hemolytic anemia in children

Rituximab for the treatment of refractory autoimmune hemolytic anemia in children

Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma†

The successful treatment of refractory autoimmune hemolytic anemia with rituximab in a patient with chronic lymphocytic leukemia

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