Mycophenolate Mofetil for the Treatment of Warm Autoimmune Haemolytic Anaemia Post-Rituximab Therapy: A Case Series.

Q3 Medicine
European journal of case reports in internal medicine Pub Date : 2024-08-14 eCollection Date: 2024-01-01 DOI:10.12890/2024_004780
Oscar F Borja-Montes, Alejandro Toro-Pedroza, Darrell D Horton, Leslie A Andritsos, Ala Ebaid
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引用次数: 0

Abstract

Background: Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data.

Case description: We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission.

Conclusion: Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA.

Learning points: Warm autoimmune haemolytic anaemia can be a challenging condition to manage. Refractory cases that are steroid-dependent can benefit from trialling steroid-sparing agents such as mycophenolate.Anti-CD20 agents such as rituximab can be very effective in refractory cases, however there is a small percentage of patients that might not be responsive to this monoclonal antibody.Autoimmune haemolytic anaemias can be frequently complicated by thrombotic events, and part of the backbone treatment is establishing good thromboprophylaxis.

霉酚酸酯治疗利妥昔单抗治疗后温热性自身免疫性溶血性贫血:病例系列。
背景:温性自身免疫性溶血性贫血(wAIHA)是一种获得性溶血性疾病,最常见的治疗方法是联合使用皮质类固醇、利妥昔单抗和/或脾切除术。治疗难治性病例的三线疗法包括免疫抑制剂。霉酚酸酯(Mycophenolate mofetil)常用于这些情况,但其使用得到了小型研究和轶事证据的支持,而非大规模数据:病例描述:我们描述了三例成功接受霉酚酸酯治疗的难治性温热型自身免疫性溶血性贫血病例。病例 1:一名 56 岁的患者因自身免疫性溶血性贫血久治不愈,最终采用霉酚酸酯治疗,成功减量类固醇,血红蛋白水平稳定,没有复发。病例 2:一名有复杂肿瘤病史(包括淋巴瘤和乳腺癌)的妇女在接受霉酚酸酯治疗后病情得到缓解,并在类固醇治疗后保持稳定。病例 3:一名 63 岁的肝硬化患者在反复出现自身免疫性贫血和深静脉血栓后,霉酚酸酯治疗有效,使其能够停用类固醇并保持病情缓解:这种疾病的治疗具有挑战性,平衡现有的治疗方法对于减少似乎无效的长期疗法可能引起的并发症至关重要。我们的病例系列展示了成功使用霉酚酸酯治疗复杂难治性 wAIHA 病例的经验:温热性自身免疫性溶血性贫血是一种具有挑战性的疾病。抗CD20药物(如利妥昔单抗)对难治性病例非常有效,但也有一小部分患者可能对这种单克隆抗体无效。自身免疫性溶血性贫血经常会并发血栓事件,因此骨干治疗的一部分就是建立良好的血栓预防措施。
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来源期刊
CiteScore
2.10
自引率
0.00%
发文量
166
审稿时长
8 weeks
期刊介绍: The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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