title: A multi-centre retrospective study of rituximab use in the treatment of relapsed or resistant warm autoimmune haemolytic anaemia.
abstract: This retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg/m(2) weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70·6% (24/34) with 26·5% (9/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87·5% (21/24) and 3 months in 12·5% (3/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12/24) relapsed during follow up with a median time to next treatment of 16·5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg/m2 weekly for four weeks at relapse and responded. There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.
authors.affiliation: Department of Haematology, University Hospital Limerick, Limerick, Ireland; Department of Haematology, Tallaght Hospital (AMNCH), Dublin, Ireland.
authors.forename: Su W
authors.initials: SW
authors.lastname: Maung
authors.forename: Maeve
authors.initials: M
authors.lastname: Leahy
authors.forename: Hilary M
authors.initials: HM
authors.lastname: O'Leary
authors.forename: Irfan
authors.initials: I
authors.lastname: Khan
authors.forename: Mary R
authors.initials: MR
authors.lastname: Cahill
authors.forename: Oonagh
authors.initials: O
authors.lastname: Gilligan
authors.forename: Philip
authors.initials: P
authors.lastname: Murphy
authors.forename: Suzanne
authors.initials: S
authors.lastname: McPherson
authors.forename: Fred
authors.initials: F
authors.lastname: Jackson
authors.forename: Mary
authors.initials: M
authors.lastname: Ryan
authors.forename: Brian
authors.initials: B
authors.lastname: Hennessy
authors.forename: Johnny
authors.initials: J
authors.lastname: McHugh
authors.forename: Matthew
authors.initials: M
authors.lastname: Goodyer
authors.forename: Larry
authors.initials: L
authors.lastname: Bacon
authors.forename: Peter
authors.initials: P
authors.lastname: O'Gorman
authors.forename: Aisling
authors.initials: A
authors.lastname: Nee
authors.forename: Michael
authors.initials: M
authors.lastname: O'Dwyer
authors.forename: Helen
authors.initials: H
authors.lastname: Enright
authors.forename: Jean
authors.initials: J
authors.lastname: Saunders
authors.forename: Denis
authors.initials: D
authors.lastname: O'Keeffe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000188:drug therapy*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007494:Ireland; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab
keywords: autoimmune haemolytic anaemia; multicentre; retrospective; rituximab; safety