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Low-dose rituximab plus steroids demonstrated safety, efficacy in autoimmune hemolytic anemia
Barcellini W. Blood. 2012;doi:10.1182/blood-2011-06-363556.
The combination of low-dose rituximab and steroids was linked to overall response rates of more than 80% in a cohort of patients with autoimmune hemolytic anemia, according to recent results.
Low-dose rituximab (Rituxan, Genentech/Idec Pharmaceuticals) was defined as 100 mg weekly for 4 weeks. A short course of steroids was added to this therapy as first- or second-line therapy for primary autoimmune hemolytic anemia. Outcome measures included safety, efficacy and duration of response. There were 23 patients in the current study.
Results indicated that after 2 months, the overall response was 82.6%. Overall response increased to 91.3% by 6 months and was 84.2% by 12 months. The overall response among patients with warm autoimmune hemolytic anemia was 100% at all time points. The average response was 60% among those with cold hemagglutinin disease.
Relapse-free survival rates were 100% among patients with warm disease at 6 and 12 months. However, cold disease was associated with relapse-free survival rates of 89% at 6 months and 59% at 12 months.
The estimated relapse-free survival at the 2-year mark is 81% for the warm form and 40% for the cold form, according to researchers. Patients with cold disease also were at higher risk for relapse. Patients with a longer interval between diagnosis and enrollment also were at an increased risk for relapse.
Cumulative dose and duration of steroid administration were reduced. The cumulative dose was reduced by approximately 50%, and duration was reduced compared with the patient’s past history.
No adverse events or infections were observed. Re-treatment demonstrated efficacy.
The clinical response correlated with amelioration biological markers, such as cytokine production — interferon-gamma, interleukin-12, tumor necrosis factor-alpha and interleukin-17 — and suggest that low-dose rituximab exerts an immunomodulating activity, the researchers concluded.
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These are very salutary results, especially in the cold agglutinin hemolytic anemia arena. When chronic, this disorder has been virtually untreatable with usual immunosuppressive regimens, including high-dose steroids. I have recently treated three such patients who suffered anemic and cold-associated ischemic symptoms for years. Remarkable improvement in all three has accompanied one or two monthly courses of rituximab. If relapse occurs down the line, I shall begin another course — with the minimal but real concern about development of multifocal encephalopathy.
Harry S. Jacob, MD, FRCPath(Hon)
HemOnc Today Chief Medical Editor