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. | ||
− | * | + | * |
===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 | ||
− | ==== Supportive care ==== | + | ====Supportive care==== |
− | * Folic acid 5 mg/day PO | + | *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] | ||
+ | |||
+ | == Sirolimus monotherapy == | ||
+ | |||
+ | === Regimen === | ||
+ | {| class="wikitable" 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]] | ||
+ | |- | ||
+ | |[http://www.bloodjournal.org/content/127/1/17 Bride et al. 2016] | ||
+ | | style="background-color:#1a9851" |Phase I/II | ||
+ | |none | ||
+ | | style="background-color:#91cf60" |Durable CR observed in patients with ALPS | ||
+ | |} | ||
+ | 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 | ||
+ | |||
+ | # 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 | |
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Benjamin Tillman, MD Vanderbilt University Nashville, TN |
4 regimens on this page
3 variants on this page
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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
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
- 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