Difference between revisions of "Warm autoimmune hemolytic anemia"
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[[#top|Back to Top]] | [[#top|Back to Top]] | ||
</div> | </div> | ||
| − | {{#lst: | + | {{#lst:Editorial board transclusions|heme}} |
| + | *''We have moved [[How I Treat]] articles to a dedicated page.'' | ||
{| class="wikitable" style="float:right; margin-right: 5px;" | {| class="wikitable" style="float:right; margin-right: 5px;" | ||
|- | |- | ||
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =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]== | ==[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] | |
| − | *'''2017:''' [https:// | + | *'''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] |
| − | *'''2016:''' [https:// | ||
| − | |||
| − | |||
| − | |||
| − | |||
=All lines of therapy= | =All lines of therapy= | ||
| − | |||
==Prednisolone monotherapy {{#subobject:5f27f2|Regimen=1}}== | ==Prednisolone monotherapy {{#subobject:5f27f2|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
| − | |||
===Regimen {{#subobject:d3c7eb|Variant=1}}=== | ===Regimen {{#subobject:d3c7eb|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
| Line 31: | Line 26: | ||
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
| − | |[https:// | + | |[https://doi.org/10.1111/bjh.12541 Birgens et al. 2013] |
| style="background-color:#1a9851" |Phase 3 (C) | | style="background-color:#1a9851" |Phase 3 (C) | ||
|[[#Prednisolone_.26_Rituximab|Prednisolone & Rituximab]] | |[[#Prednisolone_.26_Rituximab|Prednisolone & Rituximab]] | ||
| Line 37: | Line 32: | ||
|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunosuppressive therapy==== | ====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. | |
| − | *[[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/ | ||
| − | |||
* | * | ||
| − | + | </div></div> | |
===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://doi.org/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/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:// | ||
==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
| − | |||
===Regimen {{#subobject:d3c7eb|Variant=1}}=== | ===Regimen {{#subobject:d3c7eb|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
| Line 57: | Line 49: | ||
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
| − | |[https:// | + | |[https://doi.org/10.1002/ajh.24570 Michel et al. 2016 (RAIHA)] |
| style="background-color:#1a9851" |Phase 3 (C) | | style="background-color:#1a9851" |Phase 3 (C) | ||
|[[#Prednisone_.26_Rituximab|Prednisone & Rituximab]] | |[[#Prednisone_.26_Rituximab|Prednisone & Rituximab]] | ||
| Line 63: | Line 55: | ||
|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunosuppressive therapy==== | ====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" | |
| − | *[[Prednisone (Sterapred)]] | + | '''One course''' |
| − | + | </div></div> | |
===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://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] | |
| − | #'''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:// | ||
| − | |||
==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
| − | |||
===Regimen {{#subobject:a7c7eb|Variant=1}}=== | ===Regimen {{#subobject:a7c7eb|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
| Line 81: | Line 71: | ||
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
| − | |[https:// | + | |[https://doi.org/10.1111/bjh.12541 Birgens et al. 2013] |
| style="background-color:#1a9851" |Phase 3 (E-esc) | | style="background-color:#1a9851" |Phase 3 (E-esc) | ||
|[[#Prednisolone_monotherapy|Prednisolone]] | |[[#Prednisolone_monotherapy|Prednisolone]] | ||
| − | | style="background-color:#91cf60" |Seems to have superior RFS | + | | style="background-color:#91cf60" |Seems to have superior RFS (secondary endpoint) |
|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunosuppressive therapy==== | ====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. | |
| − | *[[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/ | + | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per week for 4 weeks |
| − | *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once | + | ====Supportive therapy==== |
| − | |||
| − | ====Supportive | ||
| − | |||
*Folic acid 5 mg/day PO | *Folic acid 5 mg/day PO | ||
| − | + | </div></div> | |
===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://doi.org/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/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:// | ||
==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
| − | |||
===Regimen {{#subobject:a7c9gc|Variant=1}}=== | ===Regimen {{#subobject:a7c9gc|Variant=1}}=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
| Line 110: | Line 96: | ||
! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
| − | |[https:// | + | |[https://doi.org/10.1002/ajh.24570 Michel et al. 2016 (RAIHA)] |
| style="background-color:#1a9851" |Phase 3 (E-esc) | | style="background-color:#1a9851" |Phase 3 (E-esc) | ||
|[[#Prednisone_monotherapy|Prednisone]] | |[[#Prednisone_monotherapy|Prednisone]] | ||
| − | | style="background-color:#91cf60" |Seems to have superior ORR | + | | style="background-color:#91cf60" |Seems to have superior ORR (primary endpoint) |
|- | |- | ||
|} | |} | ||
| + | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Immunosuppressive therapy==== | ====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" | |
| − | *[[Prednisone (Sterapred)]] | + | *[[Rituximab (Rituxan)]] 1000 mg IV once per day on days 1 & 15 |
| − | *[[Rituximab (Rituxan)]] | + | '''One course''' |
| − | + | </div></div> | |
===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://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] | |
| − | #'''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:// | ||
| − | |||
| − | |||
[[Category:Warm autoimmune hemolytic anemia regimens]] | [[Category:Warm autoimmune hemolytic anemia regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Autoimmune hematologic conditions]] | [[Category:Autoimmune hematologic conditions]] | ||
[[Category:Hemolytic process]] | [[Category:Hemolytic process]] | ||
Latest revision as of 11:34, 15 May 2024
| Section editor | |
|---|---|
 |
Benjamin Tillman, MD Vanderbilt University Nashville, TN, USA |
- 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
- 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
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
- 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
- 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
- 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
- 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
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 contains dosing details in abstract PubMed NCT01181154