Difference between revisions of "Warm autoimmune hemolytic anemia"
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{| class="wikitable" style="text-align:center; width:50%;" | {| class="wikitable" style="text-align:center; width:50%;" | ||
| − | !colspan="2 | + | ! colspan="2" style="color:white; font-size:125%; background-color:#31a354" align="center" |'''Section editor''' |
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| − | |style="background-color:#F0F0F0; width:15%"|[[File:Tillman_Benjamin-2.jpg|frameless|upright=0.3|center]] | + | | style="background-color:#F0F0F0; width:15%" |[[File:Tillman_Benjamin-2.jpg|frameless|upright=0.3|center]] |
| − | |style="width:35%"|<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Vanderbilt University<br>Nashville, TN</big> | + | | style="width:35%" |<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Vanderbilt University<br>Nashville, TN</big> |
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=Guidelines= | =Guidelines= | ||
==[http://www.b-s-h.org.uk/ British Society for Haematology]== | ==[http://www.b-s-h.org.uk/ British Society for Haematology]== | ||
| + | |||
*'''2017:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14654/abstract Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia] [https://www.ncbi.nlm.nih.gov/pubmed/28369704 PubMed] | *'''2017:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14654/abstract Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia] [https://www.ncbi.nlm.nih.gov/pubmed/28369704 PubMed] | ||
*'''2016:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14478/abstract The diagnosis and management of primary autoimmune haemolytic anaemia] [https://www.ncbi.nlm.nih.gov/pubmed/28005293 PubMed] | *'''2016:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14478/abstract The diagnosis and management of primary autoimmune haemolytic anaemia] [https://www.ncbi.nlm.nih.gov/pubmed/28005293 PubMed] | ||
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====Immunosuppressive therapy==== | ====Immunosuppressive therapy==== | ||
| − | *[[Prednisolone (Millipred)]] | + | |
| + | *[[Prednisolone (Millipred)]] 1.5 mg/kg/day PO for 2 weeks, then 0.75 mg/kg/day PO for 1 week (week 3), then 0.5 mg/kg/d PO for 1 week (week 4), followed by gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level. | ||
| + | |||
| + | * | ||
===References=== | ===References=== | ||
| − | # Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. [https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23981017 PubMed] | + | |
| + | #Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. [https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23981017 PubMed] | ||
==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ||
| Line 64: | Line 69: | ||
|} | |} | ||
====Immunosuppressive therapy==== | ====Immunosuppressive therapy==== | ||
| − | *[[Prednisone (Sterapred)]] | + | |
| + | *[[Prednisone (Sterapred)]] | ||
===References=== | ===References=== | ||
| − | # '''RAIHA:''' Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. [https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27696475 PubMed] | + | |
| + | #'''RAIHA:''' Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. [https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27696475 PubMed] | ||
==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ||
| Line 89: | Line 96: | ||
|} | |} | ||
====Immunosuppressive therapy==== | ====Immunosuppressive therapy==== | ||
| − | *[[Prednisolone (Millipred)]] | + | |
| − | *[[Rituximab (Rituxan)]] | + | *[[Prednisolone (Millipred)]] 1.5 mg/kg/day PO for 2 weeks, then 0.75 mg/kg/day PO for 1 week (week 3), then 0.5 mg/kg/d PO for 1 week (week 4), followed by gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level. |
| + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once weekly for 4 weeks | ||
| + | |||
| + | ==== Supportive care ==== | ||
| + | |||
| + | * Folic acid 5 mg/day PO | ||
| + | |||
===References=== | ===References=== | ||
| − | # Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. [https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23981017 PubMed] | + | |
| + | #Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. [https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/23981017 PubMed] | ||
==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ||
| Line 114: | Line 128: | ||
|} | |} | ||
====Immunosuppressive therapy==== | ====Immunosuppressive therapy==== | ||
| − | *[[Prednisone (Sterapred)]] | + | |
| + | *[[Prednisone (Sterapred)]] | ||
*[[Rituximab (Rituxan)]] | *[[Rituximab (Rituxan)]] | ||
| + | |||
===References=== | ===References=== | ||
| − | # '''RAIHA:''' Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. [https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27696475 PubMed] | + | |
| + | #'''RAIHA:''' Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. [https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/27696475 PubMed] | ||
[[Category:Warm autoimmune hemolytic anemia regimens]] | [[Category:Warm autoimmune hemolytic anemia regimens]] | ||
Revision as of 20:28, 1 October 2019
| Section editor | |
|---|---|
 |
Benjamin Tillman, MD Vanderbilt University Nashville, TN |
4 regimens on this page
3 variants on this page
|
Guidelines
British Society for Haematology
- 2017: Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia PubMed
- 2016: The diagnosis and management of primary autoimmune haemolytic anaemia PubMed
All lines of therapy
Prednisolone monotherapy
| back to top |
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Birgens et al. 2013 | Phase III (C) | Prednisolone & Rituximab | Seems to have inferior RFS |
Immunosuppressive therapy
- Prednisolone (Millipred) 1.5 mg/kg/day PO for 2 weeks, then 0.75 mg/kg/day PO for 1 week (week 3), then 0.5 mg/kg/d PO for 1 week (week 4), followed by gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.
References
- Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. link to original article PubMed
Prednisone monotherapy
| back to top |
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Michel et al. 2016 (RAIHA) | Phase III (C) | Prednisone & Rituximab | Seems to have inferior ORR |
Immunosuppressive therapy
References
- RAIHA: Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. link to original article PubMed
Prednisolone & Rituximab
| back to top |
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Birgens et al. 2013 | Phase III (E) | Prednisolone | Seems to have superior RFS |
Immunosuppressive therapy
- Prednisolone (Millipred) 1.5 mg/kg/day PO for 2 weeks, then 0.75 mg/kg/day PO for 1 week (week 3), then 0.5 mg/kg/d PO for 1 week (week 4), followed by gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.
- Rituximab (Rituxan) 375 mg/m2 IV once weekly for 4 weeks
Supportive care
- Folic acid 5 mg/day PO
References
- Birgens H, Frederiksen H, Hasselbalch HC, Rasmussen IH, Nielsen OJ, Kjeldsen L, Larsen H, Mourits-Andersen T, Plesner T, Rønnov-Jessen D, Vestergaard H, Klausen TW, Schöllkopf C. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia. Br J Haematol. 2013 Nov;163(3):393-9. Epub 2013 Aug 24. link to original article PubMed
Prednisone & Rituximab
| back to top |
Regimen
| Study | Evidence | Comparator | Efficacy |
|---|---|---|---|
| Michel et al. 2016 (RAIHA) | Phase III (E) | Prednisone | Seems to have superior ORR |
Immunosuppressive therapy
References
- RAIHA: Michel M, Terriou L, Roudot-Thoraval F, Hamidou M, Ebbo M, Le Guenno G, Galicier L, Audia S, Royer B, Morin AS, Marie Michot J, Jaccard A, Frenzel L, Khellaf M, Godeau B. A randomized and double-blind controlled trial evaluating the safety and efficacy of rituximab for warm auto-immune hemolytic anemia in adults (the RAIHA study). Am J Hematol. 2017 Jan;92(1):23-27. Epub 2016 Nov 10. link to original article PubMed