ORLANDOPatients with chronic lymphocytic leukemia (CLL)
complicated by autoimmune hemolytic anemia (AIHA) usually improve following
treatment with high-dose steroids but have few options if such treatment fails.
In a poster presented at the 43rd Annual Meeting of the American Society of
Hematology (abstract 1529), Kanti R. Rai, MD, reported long-term follow-up data
on eight such patients suggesting that a rituximab (Rituxan), cyclophosphamide,
dexamethasone combination regimen is effective not only as initial salvage
therapy in such patients but also as retreatment for relapse.
Dr. Rai said that up to 30% of CLL patients with AIHA either do not respond
to conventional steroid regimens or relapse and have a poor response to steroid
Coombs positivity and AIHA are both well-recognized complications of CLL,
Dr. Rai said. AIHA arises as a consequence of the destruction of red blood
cells mediated by autoreactive antibodies. The means by which these
autoreactive antibodies arise is as yet unknown, but it is postulated that the
imbalance of lymphocyte subsets in CLL patients leads to this complication.
Corticosteroids and intravenous immunoglobulin are the standard treatment
for AIHA. Rituximab is active in CLL, Dr. Rai said, "so using rituximab in
a patient with CLL complicated by AIHA could have two potential benefits by
eradicating the neoplastic CLL cells as well as achieving control of AIHA."
Based on that assumption, Dr. Rai, Niraj Gupta, MD, and their colleagues at
Long Island Jewish Medical Center, New Hyde Park, New York, studied rituximab,
cyclophosphamide, and dexamethasone in eight CLL patients with AIHA refractory
to steroids, intravenous gamma-globulin, or immunosuppressants.
Patients were given rituximab 375 mg/m2 IV on day 1; cyclophosphamide 750 to 1,000
mg/m² IV on day 2; and
dexamethasone 12 mg/d IV on days 1 and 2 and orally on days 3 to 7. Cycles were
repeated monthly. Blood products were given only to patients with symptomatic
anemia or thrombocytopenia.