Rituximab for autoimmune haemophilia: A proposed treatment algorithm

Anita Aggarwal*, R. Grewal, R. J. Green, L. Boggio, D. Green, B. B. Weksler, A. Wiestner, G. P. Schechter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

We previously reported durable complete responses following brief courses of rituximab and prednisone with or without cyclophosphamide in four patients with autoimmune haemophilia and inhibitor titres of 5-60 BU. We report here responses to this monoclonal anti-CD20 antibody in four additional patients, including two patients with inhibitor titres >200 BU. Factor VIII levels became normal 2-35 weeks after 4 or 8 weekly doses of rituximab, brief courses of prednisone and in one patient immunoglobulin. Complete responses are ongoing at 10 months in two patients. Two patients relapsed: a patient whose initial inhibitor titre was 525 BU relapsed at 3.5 months and a long-term prednisone-dependent patient at 8.5 months. Both responded to second courses of rituximab and prednisone and are in remission. Our experience suggests that rituximab is a safe and effective addition to immunosuppression with prednisone and cyclophosphamide to treat autoimmune haemophilia, and may permit early discontinuation or even avoidance of these potentially toxic agents. High-titre inhibitor patients, however, may require multiple courses of rituximab or the addition of cyclophosphamide. Pending randomized studies, we propose an algorithm based on our experience and other reports for incorporating rituximab in the treatment of this rare disorder.

Original languageEnglish (US)
Pages (from-to)13-19
Number of pages7
JournalHaemophilia
Volume11
Issue number1
DOIs
StatePublished - Jan 2005

Keywords

  • Autoimmune hemophilia
  • Factor VIII inhibitors
  • Rituximab

ASJC Scopus subject areas

  • Hematology
  • Genetics(clinical)

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