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Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City

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ABSTRACT

Background: Autoimmune hemolytic anemia (AIHA) is characterized by an autoimmune-mediated destruction of red blood cells. Warm AIHA (wAIHA) represents 60% of AIHA cases and is associated with the positive detection of IgG and C3d in the direct antiglobulin test (DAT). This study aimed to assess the clinical and laboratorial differences between primary and secondary wAIHA patients from a referral center in Mexico City.

Methods: All patients diagnosed with wAIHA in our institution from January 1992 to December 2015 were included and received corticosteroids as the first-line treatment. We analyzed the response to the first-line treatment, relapse-free survival, and time to splenectomy.

Results: Eighty-nine patients were included. Secondary wAIHA represented 55.1% of the cases. At diagnosis, secondary wAIHA patients showed a DAT mixed pattern more frequently than primary wAIHA patients (36.7 vs. 17.5%, P<0.001). In the survival analysis, patients with secondary wAIHA had a lower time to response (18 vs. 37 days, P=0.05), median disease-free survival (28.51 vs. 50.95 weeks, P=0.018), and time to splenectomy (43.5 vs. 61 wks, P=0.029) than those with primary wAIHA. Due to economic constraints, rituximab was considered as the third-line treatment in only two patients.

Conclusion: Secondary wAIHA may benefit from a longer low-dose steroid maintenance period mainly due to its shorter time to relapse and time to splenectomy than primary wAIHA.

No MeSH data available.


Differences in relapse-free survival between primary and secondary AIHA.
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Figure 2: Differences in relapse-free survival between primary and secondary AIHA.

Mentions: The global response (GR) of the patients receiving the first-line treatment was 84.3% with 50.6% CR and 33.7% PR. The median time to response was 27 days (range, 9–44 days). The patients in the primary group responded in 37 days (CI 95%, 2.92–71.07) whilst the secondary group responded in 18 days (CI 95%, 2.24–33.75) (P=0.05) (Fig. 1). The median DFS for primary and secondary wAIHA was 50.95 weeks (CI 95%, 16.8–85.05) and 28.51 weeks (CI 95%, 7.2–49.82), respectively (P=0.018) (Fig. 2).


Warm autoimmune hemolytic anemia: experience from a single referral center in Mexico City
Differences in relapse-free survival between primary and secondary AIHA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383587&req=5

Figure 2: Differences in relapse-free survival between primary and secondary AIHA.
Mentions: The global response (GR) of the patients receiving the first-line treatment was 84.3% with 50.6% CR and 33.7% PR. The median time to response was 27 days (range, 9–44 days). The patients in the primary group responded in 37 days (CI 95%, 2.92–71.07) whilst the secondary group responded in 18 days (CI 95%, 2.24–33.75) (P=0.05) (Fig. 1). The median DFS for primary and secondary wAIHA was 50.95 weeks (CI 95%, 16.8–85.05) and 28.51 weeks (CI 95%, 7.2–49.82), respectively (P=0.018) (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Autoimmune hemolytic anemia (AIHA) is characterized by an autoimmune-mediated destruction of red blood cells. Warm AIHA (wAIHA) represents 60% of AIHA cases and is associated with the positive detection of IgG and C3d in the direct antiglobulin test (DAT). This study aimed to assess the clinical and laboratorial differences between primary and secondary wAIHA patients from a referral center in Mexico City.

Methods: All patients diagnosed with wAIHA in our institution from January 1992 to December 2015 were included and received corticosteroids as the first-line treatment. We analyzed the response to the first-line treatment, relapse-free survival, and time to splenectomy.

Results: Eighty-nine patients were included. Secondary wAIHA represented 55.1% of the cases. At diagnosis, secondary wAIHA patients showed a DAT mixed pattern more frequently than primary wAIHA patients (36.7 vs. 17.5%, P<0.001). In the survival analysis, patients with secondary wAIHA had a lower time to response (18 vs. 37 days, P=0.05), median disease-free survival (28.51 vs. 50.95 weeks, P=0.018), and time to splenectomy (43.5 vs. 61 wks, P=0.029) than those with primary wAIHA. Due to economic constraints, rituximab was considered as the third-line treatment in only two patients.

Conclusion: Secondary wAIHA may benefit from a longer low-dose steroid maintenance period mainly due to its shorter time to relapse and time to splenectomy than primary wAIHA.

No MeSH data available.