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Probability of remaining in unsustained complete remission after steroid therapy withdrawal in patients with primary warm-antibody reactive autoimmune hemolytic anemia

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Summary

Background

Primary warm autoimmune hemolytic anemia (WAIHA) is a rare autoimmune disorder frequently responding to corticosteroid first-line treatment and effective second-line treatment options such as splenectomy or anti-CD20 antibody therapy. Disease management is frequently hampered by a lack of evidence.

Methods

We have investigated the probability of sustained treatment-free remission after steroid induction to facilitate clinical decision making regarding timing and necessity of second-line treatments. Response data from 31 patients with primary WAIHA initially treated with steroids were retrospectively analyzed. All patients responded by achieving a hemoglobin of at least 10 mg/dl.

Results

After steroid tapering and final withdrawal, 9 of 30 patients remained in unsustained complete remission (CR). The probability of remaining in CR after steroid treatment only was 38.2 % (2 SD 20.6 %) at 15 months. The median remission duration was 100 + months with a range of 12 + to 163 + months. Of note, none of the remaining patients still on steroids achieved CR beyond 15 + months.

Conclusion

These data indicate that a considerable proportion of patients do not need further treatment and that relapses will not occur after 15 months in CR.

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Acknowledgments

Expert technical assistance by Michaela Bronhagl is greatly acknowledged.

Authors’ contributions

All authors have read and approved the final version of the manuscript.

The study design was done by K. Lechner and U. Jäger. Data analysis was done by J. Kulpa, C. Skrabs, R. Simanek, P. Valent, S. Panzer, and C. Sillaber. Manuscript writing was done by K. Lechner and U. Jäger.

Conflict of interest

We hereby confirm that none of the authors has a conflict of interest with regard to the study or its results.

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Authors and Affiliations

  1. Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Johanna Kulpa, Cathrin Skrabs, Ralph Simanek, Peter Valent, Klaus Lechner, Christian Sillaber & Ulrich Jäger MD

  2. Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria

    Simon Panzer

Authors
  1. Johanna Kulpa
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  2. Cathrin Skrabs
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  3. Ralph Simanek
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  4. Peter Valent
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  5. Simon Panzer
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  6. Klaus Lechner
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  7. Christian Sillaber
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  8. Ulrich Jäger MD
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Corresponding author

Correspondence to Ulrich Jäger MD.

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Kulpa, J., Skrabs, C., Simanek, R. et al. Probability of remaining in unsustained complete remission after steroid therapy withdrawal in patients with primary warm-antibody reactive autoimmune hemolytic anemia. Wien Klin Wochenschr 128, 234–237 (2016). https://doi.org/10.1007/s00508-015-0863-y

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  • DOI: https://doi.org/10.1007/s00508-015-0863-y

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