ISSN 2997-1036
International Journal of Hematology | Vol. 1, No. 11, November 2010 | pp. 81–88
DOI: 10.46882/2010/IJH/000011
Original Article
Title: Efficacy of low-dose rituximab in the management of refractory warm autoimmune hemolytic anemia
Names of Authors: A. B. Chinedu¹, R. S. Tarfa², O. M. Kolawole³
Authors’ Affiliations: ¹Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Nigeria; ²Department of Internal Medicine, Federal Medical Centre, Azare, Nigeria; ³Department of Immunology, Obafemi Awolowo University, Ile-Ife, Nigeria
Abstract: Refractory warm autoimmune hemolytic anemia presents a severe therapeutic challenge when corticosteroid therapies fail or induce intolerable toxicities. This prospective study evaluated the clinical efficacy and safety of a low-dose rituximab protocol (100 mg weekly for 4 consecutive weeks) in 18 adult patients with corticosteroid-resistant or dependent warm autoimmune hemolytic anemia. Clinical response was defined by stabilization of hemoglobin levels above 10.0 g/dl without red blood cell transfusion support. At day 60 post-treatment, 11 patients (61.1%) achieved complete remission, and 4 patients (22.2%) achieved partial remission. The mean hemoglobin level rose significantly from a baseline of 6.2 ± 1.1 g/dl to 11.4 ± 1.5 g/dl at month 6 (P < 0.001). Reticulocyte counts and serum lactate dehydrogenase concentrations normalized in 77.8% of responsive individuals. Infusion-related adverse events were mild (Grade 1 or 2) and occurred in only 3 patients. Over a 12-month follow-up period, the relapse-free survival rate among responders was 80.0%. Low-dose rituximab exhibits substantial therapeutic efficacy, favorable safety profiles, and cost-effectiveness, offering an excellent second-line alternative for managing refractory immune hemolysis in resource-limited hematology units.
Keywords: Autoimmune hemolytic anemia, rituximab, corticosteroid-resistant, remission, hemolysis
Manuscript Timeline: Received: August 12, 2010; Revised: September 18, 2010; Accepted: October 05, 2010; Published: November 12, 2010