Synchronization of plasma exchange and cyclophosphamide in severe and refractory autoimmune hemolytic anemia.
Two cases of severe autoimmune hemolytic anemia (AIHA) that failed multiple treatment modalities obtained complete and long-lasting remissions with a combination of three one volume plasma exchange (PE) on succeeding days followed 6 hours later on the 3rd day by cyclophosphamide (cyc) 750 mg/m2 IV, and cyc/prednisone (pred) qd tapering to either no therapy or minimal therapy over a 6 month period. Both cases remain without evidence of AIHA after 43 and 19 months follow-up. Possible non-exclusive mechanisms that explain this favorable outcome are enhanced cytotoxic effect of cyc on proliferating lymphocytes participating in the antibody rebound phenomena, suppression of B lymphocytes with daily cyc/pred, and/or formation of anti-idiotype antibodies.
Silva
V A
VA
Blood Bank, Washington University Medical Center, St. Louis, Missouri.
Seder
R H
RH
Weintraub
L R
LR
D000744:Anemia, Hemolytic, Autoimmune / Q000628:therapy*; D000753:Anemia, Refractory / Q000628:therapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010951:Plasma Exchange; D012074:Remission Induction / Q000379:methods
D003520:Cyclophosphamide