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Treatment of severe autoimmune hemolytic anemia in B-cell chronic lymphocytic leukemia with alemtuzumab

Leukemia volume 21, pages 1841–1842 (2007)Cite this article

We read with interest the article by Karlsson et al.1 in Leukemia (2007), which reports five patients treated successfully with alemtuzumab (anti-CD52) for refractory autoimmune hemolytic anemia (AIHA) complicating B-cell chronic lymphocytic leukemia (B-CLL). AIHA occurs in about 5% of patients with B-CLL and requires treatment including corticosteroids, cytotoxic drugs, splenectomy or immunosuppressive drugs.2 Recently, rituximab (anti-CD20) has been used with efficacy in AHAI complicating B-CLL.3 But relapses are frequent and some patients become refractory.

We report the case of a 69-year-old woman who presented B-CLL complicated by AIHA. B-CLL was diagnosed in 1994 and was treated with different chemotherapy regimens (chlorambucile, cyclophosphamide and then fludarabine) between 1994 and 2002. In October 2003 chlorambucile was introduced for progressing B-CLL; the direct antiglobulin test (DAT) was negative. In March 2004 the patient was hospitalized in our institution for AIHA; hemoglobin (Hb) concentration was 6.4 g/dl with positive DAT. She required transfusions and corticosteroids were started at the dose of 1.5 mg/kg/day. Because of the no-response on Hb concentration and the progressive B-CLL, we decided to use alemtuzumab instead of rituximab. Alemtuzumab was intravenously administrated at conventional doses (30 mg three times weekly) for 8 weeks and corticosteroids progressively decreased from 1 to 0.5 mg/kg/day. After 1 month, Hb concentration rose to 12 g/dl in the absence of further transfusion and DAT became negative; corticosteroids were progressively reduced and stopped in February 2005. In July 2006, CLL progressed and cyclosphamide was reintroduced. Two months later AIHA relapsed with positive DAT, Hb concentration of 8.0 g/dl requiring red blood cell transfusion and corticotherapy at 1 mg/kg/day. Because of the initial efficiency of anti-CD52, we decided to reintroduce subcutaneous alemtuzumab for 11 weeks. Steroids were progressively decreased. Three months after the end of treatment with alemtuzumab, the DAT was negative, and the Hb level and the blood cells count normal. No adverse effect could be observed during this period.

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References

  1. Karlsson C, Hansson L, Celsing F, Lundin J . Treatment of severe refractory autoimmune hemolytic anemia in B-cell chronic lymphocytic leukemia with alemtuzumab (humanized CD52 monoclonal antibody). Leukemia 2007; 21: 511–514.

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  2. Mauro FR, Foa R, Cerretti R, Giannarelli D, Coluzzi S, Mandelli F et al. Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic and prognostic features. Blood 2000; 95: 2786–2792.

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  3. Robak T . Monoclonal antibodies in the treatment of autoimmune cytopenias. Eur J Haematol 2004; 72: 79–88.

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Authors and Affiliations

  1. Hematologie Clinique, Centre Hospitalier Universitaire, Amiens, Cedex 1, France

    B Royer, I Vaida, A Etienne, R Garidi, G Damaj & J P Marolleau

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  1. B Royer
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  2. I Vaida
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  3. A Etienne
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  4. R Garidi
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  5. G Damaj
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  6. J P Marolleau
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Correspondence to B Royer.

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Royer, B., Vaida, I., Etienne, A. et al. Treatment of severe autoimmune hemolytic anemia in B-cell chronic lymphocytic leukemia with alemtuzumab. Leukemia 21, 1841–1842 (2007). https://doi.org/10.1038/sj.leu.2404713

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