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Campath in haemolytic anaemia and chronic lymphatic leukaemia: an unsuccessful case

Leukemia volume 21, pages 2380–2381 (2007)Cite this article

We read with interest that Karlsson et al.1 successfully treated autoimmune haemolytic anaemia (AIHA) with Campath in five chronic lymphatic leukaemia patients achieving durable remissions. We were less fortunate in treating a 76-year-old gentleman diagnosed with stage C chronic lymphoid leukaemia (CLL) and diffuse marrow infiltration in December 2002.

Apart from Karlsson's report Campath was effective in three patients with AIHA from a British series of autoimmune cytopaenias without CLL2 and in a further patient where coincidental AIHA and CLL were suppressed for 10 months.3, 4 In our patient, AIHA and CLL relapsed 1 month after cessation of Campath without achieving marrow clearance. Interestingly, the CD38 marker had increased its expression on lymphoid cells post-Campath treatment in keeping with data showing enhanced CD38 expression in few patients variably treated with chlorambucil, epirubicin and fludarabine.5 Moreover, CD38 and ZAP70 expression are predictors of poorer prognosis, as they correlate with stage, diffuse marrow infiltration and raised lymphocyte counts.6, 7 This may explain the lack of marrow clearance that occurs in <50% of CLL patients8 and the previous lack of response to fludarabine, which was a poor prognostic indicator in itself. Likewise deletion 11q is associated with early progressive disease, shorter progression-free survival and overall survival even in patients treated with combined chemo- and immunotherapy.9 Sadly our patient passed away for acute renal failure secondary to untreatable haemolytic anaemia after the second course of fludarabine and cyclophosphamide before we could re-consider immunotherapy.

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References

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  1. Department of Hematology, Inverclyde Royal Hospital, Greenock, UK

    P R J Ames, D Aw & M G Rainey

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  1. P R J Ames
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Correspondence to P R J Ames.

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Ames, P., Aw, D. & Rainey, M. Campath in haemolytic anaemia and chronic lymphatic leukaemia: an unsuccessful case. Leukemia 21, 2380–2381 (2007). https://doi.org/10.1038/sj.leu.2404794

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