Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Manuscript
  • Published:

Rituximab-based chemotherapy for steroid-refractory autoimmune hemolytic anemia of chronic lymphocytic leukemia

Leukemia volume 16, pages 2092–2095 (2002)Cite this article

Abstract

Autoimmune hemolytic anemia (AIHA) is a well known complication of chronic lymphocytic leukemia (CLL). Steroids are the first line of treatment and there are limited effective treatment options for steroid refractory AIHA of CLL. Rituximab, an active agent against B cell malignancies, has also been noted to be active in certain autoimmune hematologic disorders. We used a combination of rituximab, cyclophosphamide and dexamethasone (RCD) in eight CLL patients with steroid refractory AIHA. Rituximab was given at a dose of 375 mg/m2 i.v. on day 1 (D-1). Cyclophosphamide was given at a dose of 750 mg/m2 on D-2. Twelve mg of dexamethasone was given i.v. on D-1, D-2 and orally from D-3 to D-7. Cycles were repeated every 4 weeks till the best response. Response in AIHA was evaluated by frequent blood counts and Coombs test. All eight patients achieved a remission of their AIHA. Median pretreatment hemoglobin was 8.3 g/dl and post-treatment hemoglobin was 14.3 g/dl. Five patients converted to Coombs negative after RCD. Median duration of response was 13 months (7–23+). Retreatment with RCD was also effective in achieving a response on relapse of AIHA. Our results indicate that a rituximab-based combination regimen (RCD) is highly effective in treating steroid refractory AIHA of CLL.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Hamblin TJ, Oscier DJ, Young BJ . Autoimmuntiy in chronic lymphocytic leukemia J Clin Pathol 1986 39: 713–719

    Article  CAS  Google Scholar 

  2. Mauro F, Foa R, Cerretti R, Giannarelli D, Coluzzi S, Mandelli F, Girelli G . Autoimmune hemolytic anemia in chronic lymphocytic leukemia. Clinical, therapeutic and prognostic features Blood 2000 95: 2786–2792

    CAS  PubMed  Google Scholar 

  3. Besa EC . Use of intravenous immunoglobulin in chronic lymphocytic leukemia Am J Med 1987 82: 159–162

    Article  Google Scholar 

  4. Emilia G, Messora C, Bensi L . The use of cyclosporine-A in the treatment of B-chronic lymphocytic leukemia Leukemia 1995 9: 357–359

    CAS  PubMed  Google Scholar 

  5. Caligaris-Cappio F, Hamblin T . B-cell chronic lymphocytic leukemia. A bird of a different feather J Clin Oncol 1999 17: 399–408

    Article  CAS  Google Scholar 

  6. Nadler LM, Ritz J, Hardy R, Van Agthoren A, Terhorst C, Schlossman S . A unique cell surface antigen identifying lymphoid malignancies of B-cell origin J Clin Invest 1981 167: 134–140

    Article  Google Scholar 

  7. Anderson KS, Bates MP, Slaughenhoupt BL, Pinkus GS, Schlossman S, Nadler LM . Expression of human B-cell associated antigen on leukemia and lymphomas: a model of human B-cell differentiation Blood 1994 63: 1424–1433

    Google Scholar 

  8. Reff ME, Carmer K, Chambers KS, Chinn P, Leonard J, Raab R, Newman R, Anderson D . Depletion of B-cells in vivo by a chimeric mouse human monoclonal antibody to CD-20 Blood 1994 83: 435–445

    CAS  PubMed  Google Scholar 

  9. McLaughlin P, Grillo-Lopez AJ, Link BK, Levy R, Czuczman M, Heyman M, White C, Jain V, Ho A, Wey K, Shen D, Dallaire BK . Rituximab chimeric anti-CD20 antibody therapy for relapsed indolent lymphoma: half of the patients responded to a four-dose treatment program J Clin Oncol 1998 16: 2825–2833

    Article  CAS  Google Scholar 

  10. Huhn D, Schiling C, Wilhelm M, Ho A, Hallek M, Knauf W, Riedel U, Srock S, Serke S, Emmerich B for the German CLL Study Group. Rituximab therapy of patients with B-cell chronic lymphocytic leukemia Blood 2001 98: 1326–1331

    Article  CAS  Google Scholar 

  11. Byrd J, Peterson B, Park K, Morrison V, Vardiman J, Jacobson R, Rai KR, Larson R . Rituximab added to fludarabine improves response in previously untreated chronic lymphocytic leukemia: preliminary results from CALGB 9712 Proc Am Acad Oncol 2001 20: 280a

    Google Scholar 

  12. Saleh MN, Gutheil J, Moore M . A pilot study of anti-CD MoAb Rituximab in patients with refractory immune thrombocytopenic purpura (ITP) Blood 2000 95: 252a

    Google Scholar 

  13. Mow BM, Hook CC . Rituximab for the treatment of refractory immune thrombocytopenia: a case report Blood 1999 94 (Suppl. 1): 82b

    Google Scholar 

  14. Perrotta AL, Sunneberg TA, Scott J . Rituxan in the treatment of chronic idiopathic thrombocytopenia purpura (ITP) Blood 1999 94: 14a

    Google Scholar 

  15. Lee E, Zamkoff K, Gentile T . Rituxan in the treatment of auto-immune hemolytic anemia (AIHA) Blood 2000 95: 596a

    Google Scholar 

  16. Berentsen S, Tjonnfjord G, Gjertsen B . Rituxan therapy for chronic cold agglutinin disease Blood 2000 95: 730a

    Google Scholar 

  17. Stasi R, Pagano A, Stipa E, Amadori S . Rituximab chimeric anti CD20 monoclonal antibody treatment for adults with idiopathic thrombocytopenic purpura Blood 2001 98: 952–957

    Article  CAS  Google Scholar 

  18. Treon S, Anderson K . The use of rituximab in the treatment of mailgnant and non malignant plasma cell disorders Semin Oncol 2000 27: 79–85

    CAS  PubMed  Google Scholar 

  19. Demidem A, Lam T, Alas S, Hariharan K, Hanna A, Bonavida B . chimeric anti-CD20 (IDEC-C2B8) monoclonal antibody sensitizes a B-cell lymphoma cell line to cell killing by cytotoxic drugs Cancer Biother Radiopharm 1997 12: 177–186

    Article  CAS  Google Scholar 

  20. Czuczman MS, Grillo-Lopez AJ, White CA, Saleh M, Gordon L, LoBuglio AF, Jonas C, Klippenstein D, Dallaire B, Varns C . Treatment of patients with low-grade B-cell lymphoma with the combination of chimeric anti-CD20 monoclonal antibody and CHOP chemotherapy J Clin Oncol 1999 17: 268–276

    Article  CAS  Google Scholar 

  21. Di Raimondo F, Giustolisi R, Cacciola E, O'Brien S, Kantarjian H, Robertson L, Keating MJ . Autoimmune hemolytic anemia in chronic lymphocytic leukemia patients treated with fludarabine Leuk Lymphoma 1993 11: 63–68

    Article  CAS  Google Scholar 

  22. Weiss R, Freiman J, Kweder S, Diehl L, Byrd JC . Hemolytic anemia after fludarabine therapy for chronic lymphocytic leukemia J Clin Oncol 1998 16: 1885–1889

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was made possible by research grant support to Dr Kanti R Rai from The Chemotherapy Foundation, The Edward Brodsky Fund and The Joel Finkelstein Cancer Foundation.

Author information

Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA

    N Gupta, S Kavuru, D Patel, D Janson, N Driscoll, S Ahmed & KR Rai

Authors
  1. N Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Kavuru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D Janson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N Driscoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. KR Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, N., Kavuru, S., Patel, D. et al. Rituximab-based chemotherapy for steroid-refractory autoimmune hemolytic anemia of chronic lymphocytic leukemia. Leukemia 16, 2092–2095 (2002). https://doi.org/10.1038/sj.leu.2402676

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2402676

Keywords

This article is cited by

Search

Advanced search

Quick links