Acquired Hemophilia A successfully treated with rituximab

Giovanni D'Arena, Elvira Grandone, Matteo Nicola Dario Di Minno, Pellegrino Musto, Giovanni Di Minno
  • Giovanni D'Arena
    Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), Italy, Italy | giovannidarena@libero.it
  • Elvira Grandone
    Affiliation not present
  • Matteo Nicola Dario Di Minno
    Affiliation not present
  • Pellegrino Musto
    Affiliation not present
  • Giovanni Di Minno
    Affiliation not present

Abstract

Acquired hemophilia A (AHA) is a rare bleeding disorder due to the development of specific autoantibodies against factor VIII. The anti-CD20 monoclonal antibody Rituximab has been proven to be effective in  obtaining a long-term suppression of inhibitors of AHA,  besides other immunosuppressive standard treatments. Here we describe a case of idiopathic AHA in a 60-year old man successfully treated with rituximab. He showed a complete clinical response with  a normalization of clotting  parameters after 5 weekly courses of rituximab given at a dose of 375 mg/sqm. , but after stopping rituximab, an initial worsening of coagulation  parameters  induced the addition of 3 further courses. At present, the patient is in complete clinical and hematological remission after 200 days.  This case confirms that Rituximab may be a safe and useful tool to treat AHA and, a prolonged administration can overcome the initial resistance. However, the precise position of this drug in the therapeutic strategy (first or second-line, alone or in combination with other drugs) remains to be established and warrants further investigation.

Keywords

acquired hemophilia; inhibitors; rituximab;

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Submitted: 2015-01-19 16:05:15
Published: 2015-02-17 00:00:00
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D’Arena G, Grandone E, Di Minno MND, Musto P, Di Minno G. Rituximab to treat adult acquired hemofilia A. Ann Hematol (submitted)

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