Difference between revisions of "Warm autoimmune hemolytic anemia"

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search
m (Text replacement - "'''Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer. If this is your first time visiting, we suggest you read the tutorial.'''" to "<!--'''Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer. If this is your first time visiting, we suggest you read the tutorial.'''-->")
m (Text replacement - "*<big>We have moved How I Treat articles to a dedicated page.</big>" to "*''We have moved How I Treat articles to a dedicated page.''")
 
(44 intermediate revisions by 4 users not shown)
Line 1: Line 1:
−
<!--'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]]. If this is your first time visiting, we suggest you read the [[tutorial]].'''-->
+
<span id="BackToTop"></span>
 +
<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
 +
[[#top|Back to Top]]
 +
</div>
 +
{{#lst:Editorial board transclusions|heme}}
 +
*''We have moved [[How I Treat]] articles to a dedicated page.''
 +
{| class="wikitable" style="float:right; margin-right: 5px;"
 +
|-
 +
|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
 +
<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 +
|}
 +
{{TOC limit|limit=3}}
 +
=Guidelines=
 +
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 +
==[http://www.b-s-h.org.uk/ British Society for Haematology]==
 +
*'''2017:''' [https://doi.org/10.1111/bjh.14654 Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia] [https://pubmed.ncbi.nlm.nih.gov/28369704/ PubMed]
 +
*'''2016:''' [https://doi.org/10.1111/bjh.14478 The diagnosis and management of primary autoimmune haemolytic anaemia] [https://pubmed.ncbi.nlm.nih.gov/28005293/ PubMed]
 +
=All lines of therapy=
 +
==Prednisolone monotherapy {{#subobject:5f27f2|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:d3c7eb|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 +
! style="width: 25%" |Study
 +
! style="width: 25%" |[[Levels_of_Evidence#Evidence|Evidence]]
 +
! style="width: 25%" |Comparator
 +
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]]
 +
|-
 +
|[https://doi.org/10.1111/bjh.12541 Birgens et al. 2013]
 +
| style="background-color:#1a9851" |Phase 3 (C)
 +
|[[#Prednisolone_.26_Rituximab|Prednisolone & Rituximab]]
 +
| style="background-color:#fc8d59" |Seems to have inferior RFS
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====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/day PO for 1 week (week 4), then a gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.
 +
*
 +
</div></div>
 +
===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://doi.org/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23981017/ PubMed]
  
−
Is there a regimen missing from this list?  Would you like to share a different dosage/schedule or an additional reference for a regimen?  Have you noticed an error?  Do you have an idea that will help the site grow to better meet your needs and the needs of many others?  You are [[How_to_contribute|invited to contribute to the site]].
+
==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}==
−
{| class="wikitable" style="text-align:center; width:100%;"
+
<div class="toccolours" style="background-color:#eeeeee">
−
!colspan="4" align="center" style="color:white; font-size:125%; background-color:#31a354"|'''Section editors'''
+
===Regimen {{#subobject:d3c7eb|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 +
! style="width: 25%" |Study
 +
! style="width: 25%" |[[Levels_of_Evidence#Evidence|Evidence]]
 +
! style="width: 25%" |Comparator
 +
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]]
 
|-
 
|-
−
|style="background-color:#F0F0F0; width:15%"|[[File:Shruti.jpg|frameless|upright=0.3|center]]
+
|[https://doi.org/10.1002/ajh.24570 Michel et al. 2016 (RAIHA)]
−
|style="width:35%"|<big>[[User:Shrutichaturvedi|Shruti Chaturvedi, MBBS, MSCI]]<br>Baltimore, MD</big><br>[https://www.linkedin.com/in/shruti-chaturvedi-bb83b126/ LinkedIn]
+
| style="background-color:#1a9851" |Phase 3 (C)
−
|style="background-color:#F0F0F0; width:15%"|[[File:Tillman_Benjamin-2.jpg|frameless|upright=0.3|center]]
+
|[[#Prednisone_.26_Rituximab|Prednisone & Rituximab]]
−
|style="width:35%"|<big>[[User:Benjamintillman|Benjamin Tillman, MD]]<br>Nashville, TN</big>
+
| style="background-color:#fc8d59" |Seems to have inferior ORR
 
|-
 
|-
 
|}
 
|}
−
There is significant overlap between this and the '''[[autoimmune cytopenias]]''' page; please check there for a relevant regimen.
+
<div class="toccolours" style="background-color:#b3e2cd">
−
{| class="wikitable" style="float:right; margin-right: 5px;"
+
====Immunosuppressive therapy====
 +
*[[Prednisone (Sterapred)]] 1 mg/kg PO once per day on days 1 to 14, then tapered "according to a pre-defined recommended reduction scheme"
 +
'''One course'''
 +
</div></div>
 +
===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://doi.org/10.1002/ajh.24570 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/27696475/ PubMed] [https://clinicaltrials.gov/study/NCT01181154 NCT01181154]
 +
==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:a7c7eb|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 100%; text-align:center;"  
 +
! style="width: 25%" |Study
 +
! style="width: 25%" |[[Levels_of_Evidence#Evidence|Evidence]]
 +
! style="width: 25%" |Comparator
 +
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]]
 +
|-
 +
|[https://doi.org/10.1111/bjh.12541 Birgens et al. 2013]
 +
| style="background-color:#1a9851" |Phase 3 (E-esc)
 +
|[[#Prednisolone_monotherapy|Prednisolone]]
 +
| style="background-color:#91cf60" |Seems to have superior RFS (secondary endpoint)
 
|-
 
|-
−
|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
 
−
<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
 
 
|}
 
|}
−
{{TOC limit|limit=3}}
+
<div class="toccolours" style="background-color:#b3e2cd">
−
=Guidelines=
+
====Immunosuppressive therapy====
−
==[http://www.b-s-h.org.uk/ British Society for Haematology]==
+
*[[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/day PO for 1 week (week 4), then a gradual reduction over the next 4 to 8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.
−
*'''2017:''' [http://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]
+
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week for 4 weeks
−
*'''2016:''' [http://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]
+
====Supportive therapy====
 +
*Folic acid 5 mg/day PO
 +
</div></div>
 +
===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://doi.org/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23981017/ PubMed]
  
−
=All lines of therapy=
+
==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}==
−
To be completed
+
<div class="toccolours" style="background-color:#eeeeee">
−
[[Category:Autoimmune hemolytic anemia (AIHA) regimens]]
+
===Regimen {{#subobject:a7c9gc|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 +
! style="width: 25%" |Study
 +
! style="width: 25%" |[[Levels_of_Evidence#Evidence|Evidence]]
 +
! style="width: 25%" |Comparator
 +
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]]
 +
|-
 +
|[https://doi.org/10.1002/ajh.24570 Michel et al. 2016 (RAIHA)]
 +
| style="background-color:#1a9851" |Phase 3 (E-esc)
 +
|[[#Prednisone_monotherapy|Prednisone]]
 +
| style="background-color:#91cf60" |Seems to have superior ORR (primary endpoint)
 +
|-
 +
|}
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Immunosuppressive therapy====
 +
*[[Prednisone (Sterapred)]] 1 mg/kg PO once per day on days 1 to 14, then tapered "according to a pre-defined recommended reduction scheme"
 +
*[[Rituximab (Rituxan)]] 1000 mg IV once per day on days 1 & 15
 +
'''One course'''
 +
</div></div>
 +
===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://doi.org/10.1002/ajh.24570 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/27696475/ PubMed] [https://clinicaltrials.gov/study/NCT01181154 NCT01181154]
 +
[[Category:Warm autoimmune hemolytic anemia regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
 
[[Category:Autoimmune hematologic conditions]]
 
[[Category:Autoimmune hematologic conditions]]
−
[[Category:Hemolytic disorders]]
+
[[Category:Hemolytic process]]

Latest revision as of 11:34, 15 May 2024

Back to Top

Section editor
Tillman Benjamin-2.jpg
 Benjamin Tillman, MD
Vanderbilt University
Nashville, TN, USA
LinkedIn
  • We have moved How I Treat articles to a dedicated page.
4 regimens on this page
3 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

British Society for Haematology

All lines of therapy

Prednisolone monotherapy

Regimen

Study Evidence Comparator Efficacy
Birgens et al. 2013 Phase 3 (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/day PO for 1 week (week 4), then a gradual reduction over the next 4-8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.

References

  1. 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

Regimen

Study Evidence Comparator Efficacy
Michel et al. 2016 (RAIHA) Phase 3 (C) Prednisone & Rituximab Seems to have inferior ORR

Immunosuppressive therapy

  • Prednisone (Sterapred) 1 mg/kg PO once per day on days 1 to 14, then tapered "according to a pre-defined recommended reduction scheme"

One course

References

  1. 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 contains dosing details in abstract PubMed NCT01181154

Prednisolone & Rituximab

Regimen

Study Evidence Comparator Efficacy
Birgens et al. 2013 Phase 3 (E-esc) Prednisolone Seems to have superior RFS (secondary endpoint)

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/day PO for 1 week (week 4), then a gradual reduction over the next 4 to 8 weeks to the lowest dose that was effective in maintaining a normal hemoglobin level.
  • Rituximab (Rituxan) 375 mg/m2 IV once per week for 4 weeks

Supportive therapy

  • Folic acid 5 mg/day PO

References

  1. 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

Regimen

Study Evidence Comparator Efficacy
Michel et al. 2016 (RAIHA) Phase 3 (E-esc) Prednisone Seems to have superior ORR (primary endpoint)

Immunosuppressive therapy

One course

References

  1. 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 contains dosing details in abstract PubMed NCT01181154
Retrieved from "https://hemonc.org/w/index.php?title=Warm_autoimmune_hemolytic_anemia&oldid=85691"