Anti-CD20 therapy for chronic lymphocytic leukemia-associated autoimmune diseases.
Rituximab is active in chronic lymphocytic leukemia (CLL) and may interfere with autoantibodies production in some immune diseases. We report the results of rituximab treatment in 7 patients with CLL-associated symptomatic autoimmune diseases refractory to standard immunosuppressive therapies: warm antibody hemolytic anemia (AHA) 4 patients, cold agglutinin disease (CAD) 1, immune thrombocytopenia (IT) 1, axonal degenerating neuropathy (ADN) 1. Rituximab was given at the dose of 375 mg/m2 per week for 4 weeks. One patient with AHA and one with CAD achieved complete normalization of hemoglobin levels and laboratory signs of haemolysis, with response duration (RD) of 8+ and 38+ months, respectively. In the patient with IT, complete remission was reached after the first week of treatment and RD was 6 months. The patient with ADN achieved a marked neurological improvement after rituximab therapy, with RD of 12 months. Retreatment of both patients with IT and ADN was effective. Rituximab may be an alternative agent for the treatment CLL-associated autoimmune diseases.
Zaja
Francesco
F
Clinica Ematologica, Policlinico Universitario, P. zza S. M. Misericordia, 33100 Udine, Italy. francesco.zaja@med.uniud.it
Vianelli
Nicola
N
Sperotto
Alessandra
A
Patriarca
Francesca
F
Tani
Monica
M
Marin
Luciana
L
Tiribelli
Mario
M
Candoni
Anna
A
Baccarani
Michele
M
Fanin
Renato
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy*; D016393:Lymphoma, B-Cell / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration / Q000188:drug therapy / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab