Warm Autoimmune Hemolytic Anemia at Relapse — When First-Line Corticosteroids Have Not Achieved Complete Response
This protocol applies to patients with warm autoimmune hemolytic anemia (wAIHA) who experience relapse after first-line corticosteroid therapy and did not achieve an adequate haematological response.
Previous treatment — failure condition
First-line therapy with corticosteroids (predniso(lo)ne) was used with the goal of improving haemoglobin levels and achieving a complete response. This protocol is triggered when that goal is not met — i.e., complete response was not achieved on the first-line regimen.
Next-line approach — partial overview
At relapse, the approach involves careful management of steroid exposure to limit toxicity, with prompt initiation of rituximab. The complete decision criteria, sequencing, and all clinical details are contained in the full structured protocol.
References
DOI: 10.33590/emjhematol/GBUF7192
At relapse, patients should start on a low dose of steroids to avoid the toxicity associated with high-dose steroids, then initiate rituximab as soon as possible.
Over 75% of patients with wAIHA respond to rituximab; however, half of these patients relapse after 1 year.
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