Use of Rituximab in Autoimmune Hemolytic Anemia Associated with Non-Hodgkin Lymphomas

Abstract

The association between non-Hodgkin lymphomas and autoimmune disorders is a well-known event. Also autoimmune hemolytic anemia (AHA), although much more frequent in patients with chronic lymphocytic leukemia (CLL), has been described in this group of patients. In recent years, among the more traditional therapeutic options, rituximab, an anti-CD20 monoclonal antibody, has shown interesting results in the treatment of primary AHA. Although this drug has been frequently used for AHA in patients with CLL, much less data are available on its use in NHL patients. However, considering that the main pathogenetic mechanism of AHA in course of lymphoproliferative disorders seems to be an antibody production directly or indirectly mediated by the neoplastic clone, this monoclonal antibody represents an ideal therapeutic approach. In this paper we will briefly describe some biological and clinical features of NHL-patients with AHA. We will then analyze some studies focusing on rituximab in primary AHA, finally reviewing the available literature on the use of this drug in NHL related AHA.

Cold agglutinin syndrome secondary to splenic marginal zone lymphoma: a case report

“…A recent review approaching the paper of rituximab on the treatment on AIHA secondary to non-Hodgkin lymphoma concluded that it represents a valid therapeutic option, although a significant proportion of patients will relapse after an initial response. 8 The treatment's choice for our patient was based on staff experience and availability.…”

Autoimmune Haemolytic Anaemia in Patients with Cancer Diagnoses

“…In Sjogren's Syndrome, there is a 44 times increased risk of developing lymphoma. The presence of AIHA increases the risk of NHL by 2.6 fold [25]. Out of 175 patients on follow up for AIHA, a malignancy was found in 14% of them [8].…”

Autoimmune Hemolisis in the Patients with B-Cell Non-Hodgkin Lymphomas

“…Аутоиммунная гемолитическая ане-мия (АИГА) осложняет течение от 3 до 6% неход-жкинских лимфом [13]. В то же время В-клеточные лимфомы в 39% случаев являются причиной вто-ричной АИГА [19].…”

“…В нашем случае были выявле-ны как изолированно С3, так и холодовые агглюти-нины и гемолизины, а также комбинация IgG/C3, которая указывает на наличие одновременно теп-ловой и холодовой аутоиммунных реакций, что, конечно же, усугубляет аутоиммунный процесс. АИГА, обусловленная холодовыми антиэритроци-тарными антителами, у больных неходжкинскими лимфомами протекает особенно злокачественно и хуже поддается лечению [13,16,18]. К тому же, холодовые агглютинины (которые преимуществен-но относятся к IgM [21]) встречались только у па-циентов группы II.…”