Difference between revisions of "Warm autoimmune hemolytic anemia"

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*[[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.
 
*[[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.
  
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*  
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*
  
 
===References===
 
===References===
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*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once weekly for 4 weeks
 
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once weekly for 4 weeks
  
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==== Supportive care ====
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====Supportive care====
  
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* Folic acid 5 mg/day PO
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*Folic acid 5 mg/day PO
  
 
===References===
 
===References===
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#'''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]
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== Sirolimus monotherapy ==
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=== Regimen ===
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{| class="wikitable" style="width: 100%; text-align:center;"
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! style="width: 25%" |Study
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! style="width: 25%" |[[Levels_of_Evidence#Evidence|Evidence]]
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! style="width: 25%" |Comparator
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! style="width: 25%" |[[Levels_of_Evidence#Efficacy|Efficacy]]
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|-
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|[http://www.bloodjournal.org/content/127/1/17 Bride et al. 2016]
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| style="background-color:#1a9851" |Phase I/II
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|none
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| style="background-color:#91cf60" |Durable CR observed in patients with ALPS
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|}
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Immunosuppressive therapy
 +
 +
* Sirolimus 2 to 2.5 mg/m<sup>2</sup> per day rounded to the nearest 0.5 (liquid) or 1 mg (tablet), starting on day 1 (maximum initial dose of 4 mg/day)
 +
 +
References
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 +
# Bride KL, Vincent T, Smith-Whitley K, Lambert MP, Bleesing JJ, Seif AE, Manno  CS, Casper J, Grupp SA, Teachey DT. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. doi: 10.1182/blood-2015-07-657981. Epub 2015 Oct 26. [http://www.bloodjournal.org/content/127/1/17 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/?term=26504182 PubMed]
  
 
[[Category:Warm autoimmune hemolytic anemia regimens]]
 
[[Category:Warm autoimmune hemolytic anemia regimens]]

Revision as of 20:44, 1 October 2019

Section editor
Tillman Benjamin-2.jpg
 Benjamin Tillman, MD
Vanderbilt University
Nashville, TN
4 regimens on this page
3 variants on this page


Guidelines

British Society for Haematology

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

  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

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

  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 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

  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

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

  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 PubMed

Sirolimus monotherapy

Regimen

Study Evidence Comparator Efficacy
Bride et al. 2016 Phase I/II none Durable CR observed in patients with ALPS

Immunosuppressive therapy

  • Sirolimus 2 to 2.5 mg/m2 per day rounded to the nearest 0.5 (liquid) or 1 mg (tablet), starting on day 1 (maximum initial dose of 4 mg/day)

References

  1. Bride KL, Vincent T, Smith-Whitley K, Lambert MP, Bleesing JJ, Seif AE, Manno CS, Casper J, Grupp SA, Teachey DT. Sirolimus is effective in relapsed/refractory autoimmune cytopenias: results of a prospective multi-institutional trial. Blood. 2016 Jan 7;127(1):17-28. doi: 10.1182/blood-2015-07-657981. Epub 2015 Oct 26. link to original article PubMed
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