title: Rituximab therapy for chronic lymphocytic leukemia-associated autoimmune hemolytic anemia.
abstract: Autoimmune hemolytic anemia (AIHA) is a well-known complication of chronic lymphocytic leukemia (CLL). In recent years the anti-CD20 monoclonal antibody rituximab has been used for the therapy of steroid-refractory AIHA and autoimmune thrombocytopenia, either idiopathic or in association with CLL. We report the results of rituximab treatment for 14 patients suffering from CLL-associated AIHA. They developed a direct antiglobulin test positive AIHA at a mean time of 47 months (range 0-135 months) from the diagnosis of CLL. In 3 cases AIHA was diagnosed at the same time as CLL. Only 1 patient had fludarabine-related AIHA. All patients received steroids as first-line treatment. At a mean time of 46 days (range 1-210 days) from the diagnosis of AIHA all patients received rituximab at a dosage of 375 mg/m(2)/weekly for 4 weeks. All patients except 3 (2 died of cardiac failure or sepsis soon after the third cycle and 1 HCV-positive patient experienced a rise in serum amino transferases) completed the scheduled four programmed cycles. First injection side effects of rituximab were minimal. All but 2 patients showed an increase in hemoglobin levels in response to rituximab (mean value 3.6 g/dl; range 0.7-10 g/dl) and a reduction in the absolute lymphocyte count and lymph nodes and spleen volume. Nine patients required packed red cell transfusions before starting rituximab; 5 no longer needed transfusions just after the second cycle and another patient after the fourth cycle. Three patients (22%) were considered to fully respond and 7 (50%) only responded partially. At a mean follow-up of 17 months, 8 patients were still alive, 6 of them transfusion-free. Our results prove that the anti-CD20 monoclonal antibody is an effective and well-tolerated alternative treatment for CLL-associated AIHA.
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, National Cancer Institute, IRCCS Fondazione G. Pascale, Naples, Italy. giovannidarena@libero.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Arena
authors.forename: Luca
authors.initials: L
authors.lastname: Laurenti
authors.forename: Silvana
authors.initials: S
authors.lastname: Capalbo
authors.forename: Alfonso Maria
authors.initials: AM
authors.lastname: D'Arco
authors.forename: Rosaria
authors.initials: R
authors.lastname: De Filippi
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Marcacci
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.forename: Sergio
authors.initials: S
authors.lastname: Storti
authors.forename: Catello
authors.initials: C
authors.lastname: Califano
authors.forename: Maria Luigia
authors.initials: ML
authors.lastname: Vigliotti
authors.forename: Michela
authors.initials: M
authors.lastname: Tarnani
authors.forename: Felicetto
authors.initials: F
authors.lastname: Ferrara
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D013256:Steroids; D000069283:Rituximab