Rituximab–cyclophosphamide–dexamethasone combination in the management of autoimmune cytopenias associated with chronic lymphocytic leukemia

ABSTRACT We report our experience on rituximab–cyclophosphamide–dexamethasone (RCD) combination therapy for the treatment of autoimmune disorders (AIDs) in 48 chronic lymphocytic leukemia

(CLL) patients. Overall, 81% of patients were relapsing for AID after previous treatment with corticosteroids, splenectomy, rituximab or alemtuzumab. Diagnosis of AID was autoimmune

hemolytic anemia (AIHA) in 26 (54%), autoimmune thrombocytopenia (AITP) in 9 (18.8%), Evan's syndrome in 8 (16.7%) and pure red cell aplasia (PRCA) in 5 patients (10.5%). Median time of

autoimmune disorder (AID) onset from CLL diagnosis was 60 months (range: 0–240), and CLL was considered progressive in 40% of subjects upon AID diagnosis (complex AID). Median hemoglobin

pre-treatment was 7.7 g/100 ml, and median platelet count 36.5 × 109/l, returning to a median of 12.5 /100ml and 37.5 × 109/l, respectively. Overall, an 89.5% response rate was obtained with

this combination, irrespective of the AID type. Relapse occurred in 19 patients (39.6%). Median duration of response for autoimmunity (DR-AI) was 24 months, but DR-AI was higher for

patients presenting: (1) AID early during CLL course (<3 years), or (2) both PRCA and AIHA. Median time to CLL progression in 48 patients was 16 months, but this time was statistically

shorter for Evan's syndrome and AITP patients as compared with AIHA and PRCA patients. This study emphasizes the relevance of CLL-directed immune chemotherapy in the management of

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Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS IBRUTINIB IN COMBINATION WITH RITUXIMAB IS HIGHLY EFFECTIVE IN TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS WITH STEROID

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would like to thank Professor G Laurent, Professor O Tournilhac, Professor B Coiffier, Professor G Salles, and Professor M Michallet for their helpful contribution in reading and discussing

the manuscript. AUTHOR INFORMATION Author notes * B Cazin and L Ysebaert: These authors are senior co-authors. AUTHORS AND AFFILIATIONS * Department of Hematology, Claude Huriez University

Hospital, Lille, France J Rossignol, R Dulery, X Leleu & B Cazin * Department of Hematology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre-Bénite, France A-S Michallet 

& A Garon * Department of Hematology, Purpan University Hospital, Toulouse, France L Oberic, M Picard, C Willekens & L Ysebaert Authors * J Rossignol View author publications You can

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AUTHOR Correspondence to L Ysebaert. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE

CITE THIS ARTICLE Rossignol, J., Michallet, AS., Oberic, L. _et al._ Rituximab–cyclophosphamide–dexamethasone combination in the management of autoimmune cytopenias associated with chronic

lymphocytic leukemia. _Leukemia_ 25, 473–478 (2011). https://doi.org/10.1038/leu.2010.278 Download citation * Received: 04 June 2010 * Revised: 01 October 2010 * Accepted: 15 October 2010 *

Published: 03 December 2010 * Issue Date: March 2011 * DOI: https://doi.org/10.1038/leu.2010.278 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this

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KEYWORDS * chronic lymphocytic leukemia * RCD * AIHA * AITP * Evan's syndrome * PRCA