Treatment of refractory fludarabine induced autoimmune haemolytic with the anti-cd20 monoclonal antibody rituximab

Ronan T Swords, A. Nolan, M. Fay, J. Quinn, R. O'Donnell, P. T. Murphy

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

A patient with cold-type autoimmune haemolytic anaemia for 8 years developed progressive B cell chronic lymphocytic leukaemia (CLL). Despite the risk of fludarabine induced exacerbation of haemolysis, he was given aggressive anti-CLL therapy with six courses of FCR (fludarabine 25 mg/m2 D1-3, cyclophosphamide 250 mg/m2 D2-4 and rituximab 375 mg/m2 D1) every 4 weeks. This resulted in a marked acute increase in haemolysis shortly after completing each course of fludarabine. However, haemolysis had settled to its baseline level by the time of subsequent courses of FCR. FCR resulted in complete clinical remission of CLL but residual haemolysis persisted. The patient was then given four weekly infusions of single agent rituximab, resulting in ongoing remission of haemolysis. In this patient, rituximab appears to have controlled fludarabine induced exacerbation of autoimmune haemolysis. In addition, subsequent single agent rituximab therapy resulted in prolonged remission of cold-type autioimmune haemolytic anaemia. It remains to be seen if the addition of rituximab will allow other patients with a positive direct Coomb's test and/or autoimmune haemolysis to receive fludarabine containing chemotherapy without undue risk of life-threatening haemolytic anaemia.

Original languageEnglish
Pages (from-to)57-59
Number of pages3
JournalClinical and Laboratory Haematology
Volume28
Issue number1
DOIs
StatePublished - Feb 1 2006
Externally publishedYes

Fingerprint

Hemolysis
Refractory materials
Monoclonal Antibodies
B-Cell Chronic Lymphocytic Leukemia
Hemolytic Anemia
Therapeutics
Chemotherapy
Cyclophosphamide
Coombs Test
Autoimmune Hemolytic Anemia
Cells
fludarabine
Rituximab
Drug Therapy

Keywords

  • Cold autoimmune haemolysis
  • Fludarabine
  • Refractory
  • Rituximab

ASJC Scopus subject areas

  • Hematology

Cite this

Treatment of refractory fludarabine induced autoimmune haemolytic with the anti-cd20 monoclonal antibody rituximab. / Swords, Ronan T; Nolan, A.; Fay, M.; Quinn, J.; O'Donnell, R.; Murphy, P. T.

In: Clinical and Laboratory Haematology, Vol. 28, No. 1, 01.02.2006, p. 57-59.

Research output: Contribution to journalArticle

Swords, Ronan T ; Nolan, A. ; Fay, M. ; Quinn, J. ; O'Donnell, R. ; Murphy, P. T. / Treatment of refractory fludarabine induced autoimmune haemolytic with the anti-cd20 monoclonal antibody rituximab. In: Clinical and Laboratory Haematology. 2006 ; Vol. 28, No. 1. pp. 57-59.
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