Warm Autoimmune Hemolytic Anemia When Rituximab Has Not Achieved an Adequate Response
This protocol applies to patients with warm autoimmune hemolytic anemia (WAIHA) whose prior treatment with Rituximab — given alongside a gradual corticosteroid taper — did not achieve the intended haematological and haemolytic targets.
Previous Line — Failure Condition That Triggers This Protocol
The preceding regimen used Rituximab (with corticosteroids weaned slowly over several weeks). This protocol is indicated when that approach failed to achieve its goals: normalisation of haemoglobin with no remaining evidence of haemolysis — meaning bilirubin, LDH, haptoglobin, and reticulocyte count were not brought to normal levels.
Next-Line Approach — Partial Overview
The approach at this stage involves either an immunosuppressive agent or an erythropoiesis-stimulating strategy, with the clinical target being a haemoglobin greater than 10 g/dL or an increase of at least 2 g/dL — full drug selection, eligibility criteria, and sequencing are available in the complete protocol.
References
DOI: 10.1182/hematology.2022000405
- If an adequate therapeutic response is not obtained after 2 or 3 months, our preferred approach is 1000mg of MMF twice a day in those who have demonstrated a strong corticosteroid response.
- In those having never had an adequate corticosteroid response or failing MMF, an ESA, such as 200 mcg of darbepoetin alfa every 2 weeks, is administered for several months in those with an endogenous erythropoietin level under 500 mIU/mL.
- The overall response rate (Hgb >10g/dL or ≥2g/dL increase in the absence of transfusions) was 55% at 15 days, 71% at 30 days, 73% at 3 months, 76% at 6 months, and 78% at 12 months.
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