-Author name in bold denotes the presenting author
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Clinically Relevant Abstract denotes an abstract that is clinically relevant.

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1766 Low Dose Rituximab Plus High Dose Dexamethasone As First-Line Treatment for Autoimmune Hemolytic AnemiaClinically Relevant Abstract

Program: Oral and Poster Abstracts
Session: 311. Disorders of Platelet Number or Function: Poster II
Hematology Disease Topics & Pathways:
antibodies, Biological, Diseases, Therapies, Immune Disorders, Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Carlos Saúl Rodríguez-Roque, MD1,2*, Andres Gomez-De Leon, MD3, Michelle Morcos-Sandino, MD1*, Nelson Josafat López-Flores, MD4*, David David Galindo-Calvillo, MD5*, Elsa Laura Zertuche-González, MD5*, Anna Cecilia Rodríguez-Zuñiga, MD4* and David Gomez-Almaguer, MD 3

1Hematology Service, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Monterrey, NL, Mexico
2Universidad Autónoma de Nuevo León, Monterrey, MEX
3Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio Gonzalez", Servicio de Hematología, Monterrey, Mexico
4Hospital Universitario "Dr. José E. González", Hematology Service, Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
5Hospital Universitario "Dr. José E. González", Hematology Service, Universidad Autónoma de Nuevo León, Monterrey, Mexico

Introduction

Corticosteroids are the first line therapy for autoimmune hemolytic anemia (AIHA), but are associated with significant adverse events, dependency and frequent relapses. Rituximab is reserved for severe or steroid-resistant disease. Low-dose rituximab is also effective, but its efficacy in the first line has been poorly described. We report our results with this combination.

Methods

Adults older than 16 years newly diagnosed with warm antibody AIHA either primary or secondary were included. Patients systematically received dexamethasone 40 mg for 4 days followed by a 1 mg/kg rapid prednisone taper plus rituximab 100 mg weekly for 4 doses. Our primary outcome was response at day 28 based on the First International Consensus Meeting (complete response: normalization of Hb, no evidence of hemolysis and absence of transfusions; response: increase of Hb by >2g/dl, or normalization of biochemical resolution of hemolysis or absence of transfusion in 7 days), secondary outcome was event-free survival with an event defined as a laboratory or clinical relapse or loss of response.

Results

Sixteen patients were treated with low-dose rituximab during the study period, ten women (62.5%), six men (37.5%). The median age was 34 years (range, 17-78). Three (18.75%) were secondary to lupus erythematosus. The median follow-up was 20 months (range, 0.4-66). Most received 4 doses of rituximab (87.5%). All patients responded at day 28, (100%) 31.2% achieved a complete response (CR). Subsequently, 81.3% achieved CR. Ten (62.5%) were considered steroid-dependent, however, most discontinued treatment without loss of response (75%). The event-free survival was 63.8% to 5 years.

Conclusion

Low-dose rituximab therapy as a first-line in AIHA showed encouraging results as most patients were able to discontinue treatment without relapse.

Disclosures: Gomez-Almaguer: Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

*signifies non-member of ASH