title: Successful anti-CD20 monoclonal antibody treatment of severe autoimmune hemolytic anemia due to warm reactive IgM autoantibody in a child with common variable immunodeficiency.
abstract: Autoimmune hemolytic anemia due to warm reactive IgM autoantibodies is unusual, severe, and often fails to respond to standard immunosuppressive therapies in both adults and children. A 6-year-old girl with common variable immunodeficiency had longstanding steroid dependent, splenectomy-unresponsive, warm IgM autoantibody-mediated autoimmune hemolytic anemia. Rituximab, a monoclonal antibody directed against CD20 antigen, was used to deplete B lymphocytes and reduce autoantibody production. She received a total of six doses of rituximab (375 mg/m2). Therapy was well tolerated, and B-lymphocytes were effectively depleted from the peripheral blood. The patient was completely tapered off glucocorticoids. The patient has remained off immunosuppressive agents for 16 months despite the return of B lymphocytes to the peripheral circulation. She continues to require IVIG. Early treatment with rituximab might be an option for patients with warm reactive IgM autoantibody-mediated autoimmune hemolytic anemia not responding to other treatments or experiencing untoward side effects from those treatments.
authors.affiliation: Division of Clinical Allergy and Immunology, Childrens Hospital, Los Angeles, California 90027, USA. Mwakim@chla.usc.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Wakim
authors.forename: Ami
authors.initials: A
authors.lastname: Shah
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Arndt
authors.forename: George
authors.initials: G
authors.lastname: Garratty
authors.forename: Kenneth
authors.initials: K
authors.lastname: Weinberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Hofstra
authors.forename: Joseph
authors.initials: J
authors.lastname: Church
mesh_terms: D000743:Anemia, Hemolytic / Q000188:drug therapy* / Q000209:etiology* / Q000276:immunology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D015703:Antigens, CD / Q000097:blood / Q000276:immunology; D018951:Antigens, CD20 / Q000097:blood / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D007223:Infant; D008212:Lymphocyte Depletion; D011239:Prednisolone / Q000627:therapeutic use; D017701:Reticulocyte Count; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015703:Antigens, CD; D018951:Antigens, CD20; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab; D011239:Prednisolone