title: Rituximab for warm-type idiopathic autoimmune hemolytic anemia: a retrospective study of 11 adult patients.
abstract: Warm-type idiopathic autoimmune hemolytic anemia (AIHA) is a relatively common hematologic disorder resulting from autoantibody production against red blood cells. Steroids represent the first-line therapeutic option, and immunosuppressive agents as well as splenectomy are used for refractory cases. Recently, the anti-CD20 monoclonal antibody rituximab has been shown to control autoimmune hemolysis in patients with refractory chronic disease. We report results from a retrospective analysis of 11 adult patients receiving rituximab for steroid-refractory AIHA of the warm type at a mean age of 55 yr (range 23-81 yr). All patients were given methyl-prednisolone as first-line treatment and some of them also received azathioprine and intravenous high-dose immunoglobulins. One patient underwent splenectomy. All patients were considered refractory to steroids and/or immunosuppressive drugs and all were then given weekly rituximab (375 mg/m(2)) for four consecutive weeks. An increase in hemoglobin (Hgb) levels in response to rituximab, with a mean increment of 3.3 g/dL (95% CI 2.1-4.4), was observed in all cases. Four patients required packed red cell transfusions before starting rituximab and all became transfusion-free. At a mean follow-up of 604 d (range 30-2884 d) since the treatment of AIHA with rituximab, all patients are alive, eight (73%) of them in complete remission (CR) and three (27%) in partial remission (PR). A moderate hemolysis still persisted in six (54%) patients. In conclusion, our experience clearly demonstrates that anti-CD20 monoclonal antibody rituximab is an effective and safe alternative treatment option for idiopathic AIHA, in particular, for steroid-refractory disease.
authors.affiliation: Hematology, Oncology and Bone Marrow Transplantation Unit, National Cancer Institute, Fondazione 'Pascale', Naples, Italy. giovannidarena@libero.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Arena
authors.forename: Catello
authors.initials: C
authors.lastname: Califano
authors.forename: Mario
authors.initials: M
authors.lastname: Annunziata
authors.forename: Alfredo
authors.initials: A
authors.lastname: Tartarone
authors.forename: Silvana
authors.initials: S
authors.lastname: Capalbo
authors.forename: Oreste
authors.initials: O
authors.lastname: Villani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amendola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pietrantuono
authors.forename: Felicetto
authors.initials: F
authors.lastname: Ferrara
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Alfonso Maria
authors.initials: AM
authors.lastname: D'Arco
authors.forename: Nicola
authors.initials: N
authors.lastname: Cascavilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies