ISSN 2997-1036
International Journal of Hematology | Vol. 10, No. 3, March 2019 | pp. 17–24
DOI: 10.46882/2019/IJH/000111
Original Article
Title: Clinical outcomes of low-dose rituximab maintenance in elderly patients with relapsed warm autoimmune hemolytic anemia
Names of Authors: A. I. Ibrahim¹, C. D. Balogun², E. O. Ojo³
Authors’ Affiliations: ¹Department of Haematology, Ahmadu Bello University, Zaria, Nigeria; ²Department of Medicine, University of Ilorin, Ilorin, Nigeria; ³Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
Abstract: Elderly individuals face heightened vulnerability to standard high-dose immunosuppressive strategies for managing relapsed warm autoimmune hemolytic anemia. This prospective clinical trial evaluated the therapeutic efficiency and safety profile of an ultra-low-dose rituximab maintenance protocol (100 mg fixed dose monthly for 6 months) in 28 elderly patients (aged ≥ 65 years) who achieved partial remission after initial steroid induction. Full blood counts, reticulocyte percentages, and serum lactate dehydrogenase concentrations tracked metabolic hemolysis. Complete hematological remission was achieved and maintained in 71.4% (20 of 28) of the patients at month 12. The mean hemoglobin concentration rose from a post-induction baseline of 8.4 ± 1.2 g/dl to 12.4 ± 1.4 g/dl at the conclusion of maintenance therapy (P < 0.001). Grade 1 or 2 infusion-related adverse reactions were documented in 14.2% of the cases, and no severe opportunistic infections occurred. These findings confirm that a structured low-dose rituximab maintenance protocol provides durable, safe, and cost-effective clinical control, minimizing the toxicities associated with long-term corticosteroid exposure in older cohorts.
Keywords: Autoimmune hemolytic anemia, rituximab, elderly patients, maintenance therapy, hemolysis
Manuscript Timeline: Received: December 14, 2018; Revised: January 20, 2019; Accepted: February 10, 2019; Published: March 15, 2019