Difference between revisions of "Warm autoimmune hemolytic anemia"
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==[http://www.b-s-h.org.uk/ British Society for Haematology]== | ==[http://www.b-s-h.org.uk/ British Society for Haematology]== | ||
| − | *'''2017:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14654/abstract Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia] [https:// | + | *'''2017:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14654/abstract Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia] [https://pubmed.ncbi.nlm.nih.gov/28369704 PubMed] |
| − | *'''2016:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14478/abstract The diagnosis and management of primary autoimmune haemolytic anaemia] [https:// | + | *'''2016:''' [https://onlinelibrary.wiley.com/doi/10.1111/bjh.14478/abstract The diagnosis and management of primary autoimmune haemolytic anaemia] [https://pubmed.ncbi.nlm.nih.gov/28005293 PubMed] |
=="How I Treat"== | =="How I Treat"== | ||
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===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://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https:// | + | #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://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23981017 PubMed] |
==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ==Prednisone monotherapy {{#subobject:58ugf2|Regimen=1}}== | ||
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===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://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https:// | + | #'''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://pubmed.ncbi.nlm.nih.gov/27696475 PubMed] |
==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ==Prednisolone & Rituximab {{#subobject:598gf2|Regimen=1}}== | ||
| Line 109: | Line 109: | ||
===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://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https:// | + | #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://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12541 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23981017 PubMed] |
==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ==Prednisone & Rituximab {{#subobject:91ugf2|Regimen=1}}== | ||
| Line 137: | Line 137: | ||
===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://onlinelibrary.wiley.com/doi/full/10.1002/ajh.24570 link to original article] [https:// | + | #'''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://pubmed.ncbi.nlm.nih.gov/27696475 PubMed] |
Revision as of 19:07, 3 June 2021
| 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
"How I Treat"
- 2021: Barcellini & Fattizzo How I treat warm autoimmune hemolytic anemia
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