Difference between revisions of "Acquired hemophilia A"
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===Regimen {{#subobject:84e0fd|Variant=1}}=== | ===Regimen {{#subobject:84e0fd|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
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− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
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|[http://www.bloodjournal.org/content/109/5/1870.long Collins et al. 2007] | |[http://www.bloodjournal.org/content/109/5/1870.long Collins et al. 2007] | ||
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===Variant #1 {{#subobject:852fed|Variant=1}}=== | ===Variant #1 {{#subobject:852fed|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[http://annals.org/article.aspx?articleid=710728 Shaffer et al. 1997] | |[http://annals.org/article.aspx?articleid=710728 Shaffer et al. 1997] | ||
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===Variant #2 {{#subobject:852fed|Variant=1}}=== | ===Variant #2 {{#subobject:852fed|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[https://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291096-8652%28199901%2960:1%3C70::AID-AJH12%3E3.0.CO;2-D/abstract Bayer et al. 1999] | |[https://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291096-8652%28199901%2960:1%3C70::AID-AJH12%3E3.0.CO;2-D/abstract Bayer et al. 1999] | ||
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===Variant #3 {{#subobject:404cf3|Variant=1}}=== | ===Variant #3 {{#subobject:404cf3|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0038-1649664 Green et al. 1993] | |[https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0038-1649664 Green et al. 1993] | ||
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===Regimen {{#subobject:6e2d2d|Variant=1}}=== | ===Regimen {{#subobject:6e2d2d|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[http://www.bloodjournal.org/content/109/5/1870.long Collins et al. 2007] | |[http://www.bloodjournal.org/content/109/5/1870.long Collins et al. 2007] | ||
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===Regimen {{#subobject:c5ce2e|Variant=1}}=== | ===Regimen {{#subobject:c5ce2e|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pubmed/6792737 Green et al. 1981] | |[https://www.ncbi.nlm.nih.gov/pubmed/6792737 Green et al. 1981] | ||
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===Variant #1, low-dose {{#subobject:3f2f14|Variant=1}}=== | ===Variant #1, low-dose {{#subobject:3f2f14|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[http://www.maneyonline.com/doi/full/10.1179/1607845414Y.0000000152 Yao et al. 2014] | |[http://www.maneyonline.com/doi/full/10.1179/1607845414Y.0000000152 Yao et al. 2014] | ||
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===Variant #2, standard-dose {{#subobject:3f9925|Variant=1}}=== | ===Variant #2, standard-dose {{#subobject:3f9925|Variant=1}}=== | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
− | !Study | + | !style="width: 50%"|Study |
− | ![[Levels_of_Evidence#Evidence|Evidence]] | + | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] |
|- | |- | ||
|[https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2516.2006.01342.x Field et al. 2006] | |[https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2516.2006.01342.x Field et al. 2006] |
Revision as of 02:19, 19 August 2018
Section editors | |||
---|---|---|---|
Shruti Chaturvedi, MBBS, MSCI Baltimore, MD |
Benjamin Tillman, MD Nashville, TN |
5 regimens on this page
7 variants on this page
|
This page is meant to cover regimens that are used in the context of acquired factor inhibitors. See the inherited coagulopathy page for regimens relevant to inherited factor deficiency.
Guidelines
- 2009: International Recommendations On The Diagnosis And Treatment Of Patients With Acquired Hemophilia A
Acquired hemophilia A, all lines of therapy
Incidence: 1.48/million/year[1]
Cyclophosphamide & Prednisolone
back to top |
Regimen
Study | Evidence |
---|---|
Collins et al. 2007 | Review |
Immunosuppressive therapy
- Cyclophosphamide (Cytoxan) 1 to 2 mg/kg PO once per day
- Prednisolone (Millipred) 1 mg/kg PO once per day
References
- Collins PW, Hirsch S, Baglin TP, Dolan G, Hanley J, Makris M, Keeling DM, Liesner R, Brown SA, Hay CR; UK Haemophilia Centre Doctors' Organisation. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation. Blood. 2007 Mar 1;109(5):1870-7. link to original article PubMed
Cyclophosphamide & Prednisone
back to top |
Variant #1
Study | Evidence |
---|---|
Shaffer et al. 1997 | Case report |
Immunosuppressive therapy
- Cyclophosphamide (Cytoxan) 100 to 200 mg PO once per day
- Prednisone (Sterapred) 50 to 80 mg PO once per day
- Per Shaffer et al. 1997: "the lower ends of these ranges became the standard therapy to minimize side effects"
Used until therapeutic response. "Cyclophosphamide and prednisone were continued at full doses until the factor VIII inhibitor titer decreased to zero; after this, the doses of prednisone and cyclophosphamide were slowly decreased."
Variant #2
Study | Evidence |
---|---|
Bayer et al. 1999 | Case report |
Immunosuppressive therapy
- Cyclophosphamide (Cytoxan) 100 PO once per day
- Prednisone (Sterapred) 1 mg/kg PO once per day
Used until therapeutic response. "Prednisone and cyclophosphamide were tapered slowly."
Variant #3
Study | Evidence |
---|---|
Green et al. 1993 | Randomized, <20 pts (E) |
Preceding treatment
- Prednisone x 21 d, with no response
Immunosuppressive therapy
- Cyclophosphamide (Cytoxan) 2 mg/kg (route not specified) once per day
- Prednisone (Sterapred) 1 mg/kg PO once per day
References
- Case series: Herbst KD, Rapaport SI, Kenoyer DG, Stanton W, Feinstein DI. Syndrome of an acquired inhibitor of factor VIII responsive to cyclophosphamide and prednisone. Ann Intern Med. 1981 Nov;95(5):575-8. link to original article PubMed
- Green D, Rademaker AW, Briët E. A prospective, randomized trial of prednisone and cyclophosphamide in the treatment of patients with factor VIII autoantibodies. Thromb Haemost. 1993 Nov 15;70(5):753-7. link to original article PubMed
- Shaffer LG, Phillips MD. Successful treatment of acquired hemophilia with oral immunosuppressive therapy. Ann Intern Med. 1997 Aug 1;127(3):206-9. link to original article contains verified protocol PubMed
- Bayer RL, Lichtman SM, Allen SL, Budman DR, Buchbinder A, Fetten J, Kolitz J, Loscalzo J. Acquired factor VIII inhibitors--successful treatment with an oral outpatient regimen. Am J Hematol. 1999 Jan;60(1):70-1. link to original article contains verified protocol PubMed
- Case series: Collins PW, Hirsch S, Baglin TP, Dolan G, Hanley J, Makris M, Keeling DM, Liesner R, Brown SA, Hay CR; UK Haemophilia Centre Doctors' Organisation. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation. Blood. 2007 Mar 1;109(5):1870-7. link to original article PubMed
Prednisolone monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Collins et al. 2007 | Review |
Immunosuppressive therapy
- Prednisolone (Millipred) 1 mg/kg PO once per day
References
- Collins PW, Hirsch S, Baglin TP, Dolan G, Hanley J, Makris M, Keeling DM, Liesner R, Brown SA, Hay CR; UK Haemophilia Centre Doctors' Organisation. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation. Blood. 2007 Mar 1;109(5):1870-7. link to original article PubMed
Prednisone monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Green et al. 1981 | Case report, review |
Green et al. 1993 | Non-randomized portion of RCT |
Immunosuppressive therapy
- Prednisone (Sterapred) 1 mg/kg PO once per day
Varying duration
Subsequent treatment
- Green et al. 1993, if no response after 21 days: Cyclophosphamide versus Cyclophosphamide & Prednisone
References
- Case series: Green D, Lechner K. A survey of 215 non-hemophilic patients with inhibitors to Factor VIII. Thromb Haemost. 1981 Jun 30;45(3):200-3. PubMed
- Case series: Spero JA, Lewis JH, Hasiba U. Corticosteroid therapy for acquired F VIII:C inhibitors. Br J Haematol. 1981 Aug;48(4):635-42. link to original article PubMed content property of HemOnc.org
- Green D, Rademaker AW, Briët E. A prospective, randomized trial of prednisone and cyclophosphamide in the treatment of patients with factor VIII autoantibodies. Thromb Haemost. 1993 Nov 15;70(5):753-7. link to original article PubMed
- Review: Delgado J, Jimenez-Yuste V, Hernandez-Navarro F, Villar A. Acquired haemophilia: review and meta-analysis focused on therapy and prognostic factors. Br J Haematol. 2003 Apr;121(1):21-35. link to original article
Rituximab monotherapy
back to top |
Variant #1, low-dose
Study | Evidence |
---|---|
Yao et al. 2014 | Case report |
Immunosuppressive therapy
- Rituximab (Rituxan) 100 mg/m2 IV once per day on days 1, 8, 15, 22
28-day course
Variant #2, standard-dose
Study | Evidence |
---|---|
Field et al. 2006 | Case series |
Immunosuppressive therapy
- Rituximab (Rituxan) 375 mg/m2 IV once per day on days 1, 8, 15, 22
28-day course
References
- Field JJ, Fenske TS, Blinder MA. Rituximab for the treatment of patients with very high-titre acquired factor VIII inhibitors refractory to conventional chemotherapy. Haemophilia. 2007 Jan;13(1):46-50. link to original article contains protocol PubMed
- Review: Franchini M. Rituximab in the treatment of adult acquired hemophilia A: a systematic review. Crit Rev Oncol Hematol. 2007 Jul;63(1):47-52. link to original article PubMed
- Yao Q, Zhu X, Liu Y, Zhang F, Yuan T, Xu J, Wang X. Low-dose rituximab in the treatment of acquired haemophilia. Hematology. 2014 Dec;19(8):483-6. link to original article PubMed
References
- ↑ Collins PW, Hirsch S, Baglin TP, Dolan G, Hanley J, Makris M, Keeling DM, Liesner R, Brown SA, Hay CR; UK Haemophilia Centre Doctors' Organisation. Acquired hemophilia A in the United Kingdom: a 2-year national surveillance study by the United Kingdom Haemophilia Centre Doctors' Organisation. Blood. 2007 Mar 1;109(5):1870-7. link to original article PubMed