Difference between revisions of "Warm autoimmune hemolytic anemia"
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Revision as of 02:04, 26 September 2020
| 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-esc) | 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-esc) | 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