Rituximab in steroid refractory autoimmune hemolytic anemia

Some patients feel mild side effects during or up to 24 hours after receiving rituximab. These usually occur with the first infusion, and can include mild throat tightening, flu-like symptoms, rash, itchiness, dizziness, back pain, nausea, upset stomach, sweating, nervousness, muscle stiffness, and numbness. These symptoms can be reduced by receiving a steroid injection before the infusion, along with acetaminophen (Tylenol) and diphenhydramine (Benadryl). The infusion is sometimes stopped for a short while and then restarted at a slower rate if the symptoms get better. Rarely, patients will have more serious symptoms, such as wheezing, mouth or throat swelling, trouble breathing, or chest pain. Patients who experience these symptoms should tell their health care providers immediately; patients may receive stronger medications to treat those symptoms.

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In a phase II clinical trial, Martinez et al (2009) examined the safety and effectiveness of alemtuzumab in treating steroid-refractory acute GVHD (aGVHD) grade II or higher after stem cell transplantation.  A total of 10 adult patients (6 with aGVHD grade III and 4 with aGVHD grade IV) were included in the study.  Nine patients had gastrointestinal tract involvement, 7 had skin involvement, and 5 had liver involvement.  Five patients responded to treatment, 2 with CR and 3 with partial response.  Eight infectious events (4 of grade 3 to 4) and 7 CMV re-activations were observed.  Six patients had grade 3 to 4 cytopenia.  All 10 patients died (7 resulting from aGVHD progression, 2 from severe infection, and 1 from to leukemia relapse), at a median of 40 days (range of 4 to 88 days) after alemtuzumab treatment.  Overall, these findings suggested that steroid-refractory aGVHD may be improved by treatment with alemtuzumab, but that this treatment does not overcome the dismal prognosis of patients with severe aGVHD, demonstrating the need for alternative therapies to treat this complication.

Unlike type I IFNs, Interferon gamma is not approved yet for the treatment of any , improved survival was observed when Interferon gamma was administrated to patients with bladder carcinoma and melanoma cancers. The most promising result was achieved in patients with stage 2 and 3 of ovarian carcinoma .The in vitro study of IFN-gamma in cancer cells is more extensive and results indicate anti-proliferative activity of IFN-gamma leading to the growth inhibition or cell death, generally induced by apoptosis but sometimes by autophagy . [40]

Rituximab in steroid refractory autoimmune hemolytic anemia

rituximab in steroid refractory autoimmune hemolytic anemia

Unlike type I IFNs, Interferon gamma is not approved yet for the treatment of any , improved survival was observed when Interferon gamma was administrated to patients with bladder carcinoma and melanoma cancers. The most promising result was achieved in patients with stage 2 and 3 of ovarian carcinoma .The in vitro study of IFN-gamma in cancer cells is more extensive and results indicate anti-proliferative activity of IFN-gamma leading to the growth inhibition or cell death, generally induced by apoptosis but sometimes by autophagy . [40]

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