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(Drug information on rituximab) (Rituxan), cyclophosphamide(Drug information on cyclophosphamide), dexamethasone(Drug information on 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 retreatment.
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.