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

Hernández-Company, Alonso; Manuel, Anguiano-Alvarez Victor; Carmona, Amir; Sergio, Rodriguez-Rodriguez; Allan, Pomerantz; López‐Karpovitch, Xavier; Juventina, Tuna-Aguilar Elena

doi:10.5045/br.2017.52.1.44

Cited by 19 publications

(21 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 Approximately 70% of patients with primary warm AIHA respond to splenectomy, 12 and this continues to be a useful second-line option when economic restraints limit access to rituximab. 24 The infective and thrombotic complications following splenectomy are well recognized. Small series suggest~30% relapse in the short term, 17,25 but unlike splenectomy for ITP, the long-term durability of remission is unknown.…”

Section: Primary Warm Aihamentioning

confidence: 99%

Autoimmune hemolytic anemia

2018

View full text Add to dashboard Cite

The diagnosis of autoimmune hemolytic anemia (AIHA) can be made with a stepwise approach that aims to identify laboratory and clinical evidence of hemolysis and then determine the immune nature of hemolysis with the direct anti-globulin test. Once alternative causes for these findings have been excluded, AIHA is established, and the clinician must search for secondary causes, as well as identify the type of AIHA. Rituximab is now the preferred second-line treatment for primary warm AIHA and first-line treatment for primary cold agglutinin disease (CAD), either as monotherapy or combined with bendamustine. Complement inhibitors have shown utility in stabilizing AIHA patients with acute severe hemolysis. Future prospects are discussed and include the C1s inhibitor BIVV009 (sutimlimab) that is now entering phase 3 studies for CAD.

show abstract

Section: Primary Warm Aihamentioning

confidence: 99%

Autoimmune hemolytic anemia

2018

View full text Add to dashboard Cite

show abstract

“…Steroids remain the mainstay of therapy, being effective in 70–80% of patients [456]. Recently rituximab has emerged as an additional resource with fewer secondary effects than traditional immunosuppressive agents, which has led to this biological agent being formally recommended for second line therapy, displacing splenectomy.…”

Section: Introductionmentioning

confidence: 99%

Treatment of autoimmune hemolytic anemia: real world data from a reference center in Mexico

et al. 2019

View full text Add to dashboard Cite

Background Warm autoimmune hemolytic anemia (w-AIHA) is an uncommon disease with heterogeneous response to treatment. Steroids are the standard treatment at diagnosis, whereas rituximab has recently been recommended as the second-line therapy of choice. Our main objective was to document the response to treatment in patients with newly diagnosed w-AIHA, including the effectiveness of low-dose rituximab as frontline treatment and for refractory disease. Methods Patients with w-AIHA from 2002 to 2017 were included. Relapse-free survival (RFS), probability of maintained response (MR), and time-to-response were analyzed using the Kaplan–Meier method. Response was classified as complete, partial, and no response. Results We included 64 adults with w-AIHA (39 women and 25 men). The median age was 37 (16–77) years. Response rates to steroids alone were 76.7%, rituximab plus steroids, 100%; and cyclophosphamide, 80%. RFS with steroids at 6, 36, and 72 months was 86.3%, 65.1%, and 59.7%, respectively. Eighteen patients received rituximab at 100 mg/wk for 4 weeks plus high-dose dexamethasone as first-line therapy, with RFS at 6, 36, and 72 months of 92.3%, 58.7% and 44.1%, respectively. Eight patients refractory to several lines of therapy were treated with low-dose rituximab, and all achieved a response (three complete response and five partial response) at a median 16 days (95% confidence interval, 14.1–17.8), with a 75% probability of MR at 103 months; the mean MR was 81.93±18 months. Conclusion Outcomes of w-AIHA treatment were considerably heterogeneous. Low rituximab doses plus high dexamethasone doses were effective for refractory disease.

show abstract

“…The aim of this study is evaluating the frequency and clinical characteristics of SMM in patients with wAIHA, as well as comparing the differences in the response rates and disease-free survival (DFS) with those without SMM (categorized as individuals with splenic congestion). In addition to our previous report regarding the differences between primary and secondary AIHA [ 10 ], we describe the clinical and pathological implications in our splenectomized patients in this paper.…”

Section: Introductionmentioning

confidence: 89%

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

et al. 2018

View full text Add to dashboard Cite

BackgroundSplenic myeloid metaplasia (SMM) is a kind of extramedullary hematopoiesis, whereas its clinical significance in wAIHA remains unclear. The aim of this study is evaluating the frequency and clinical characteristics of SMM, compared with splenic-congestion (SC).MethodsWe included patients with wAIHA treated in a Mexican tertiary hospital between January 1992 and December 2015. All patients received steroids as first-line treatment and splenectomy as second-line treatment.ResultsAmong the thirty-six splenectomized patients, 15 (41.6%) and 21 (58.4%) were diagnosed as SMM and SC, respectively. No differences were found in clinical characteristics between two groups. SMM patients showed lower platelet count (147×109/L vs. 240×109/L, P=0.02) and higher presence of anti-dsDNA antibodies (40% vs. 4.7%, P=0.01) than SC patients. Although the complete response (CR) rate with first-line treatment was lower in SMM patients (13.3% vs. 47.6%; P=0.04), post-splenectomy median disease-free-survival (DFS) was longer (16.2 mo vs. 5.1 mo; P=0.19). Univariate/multivariate analysis showed that achieving CR during first-line treatment (OR 0.3, 95% CI: 0.03–0.94, P=0.03) and higher platelet count (OR 0.99, 95% CI: 0.98–0.99, P=0.03) were protective factors for SMM; and anti-dsDNA titer higher than 9.6 IU/dL was a risk factor for SMM (OR 2.76, 95% CI: 1.48–5.14, P<0.001).ConclusionThe wAIHA patients with SMM have different biological profiles with those without SMM. This study is the first trial evaluating the significance of histopathological spleen findings and their association with rheumatologic profile.

show abstract

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

Cited by 19 publications

References 22 publications

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia

Treatment of autoimmune hemolytic anemia: real world data from a reference center in Mexico

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

Contact Info

Product

Resources

About