Clinical characteristics of cases with alemtuzumab associated AIHA
| Features . | Case A (present case) . | Case B (CARE MS I trial)8 . | Case C (CARE MS II trial)16 . | Case D (CARE MS extension trial)9> . | Case E(Meunier et al)10 . | Case F (Di Ioia et al)11 . | Case G(Rieckmann et al)12 . | Case H (Tzartos et al)14 . | Case I (Metz et al)13 . | Case J(Alnahdi et al)15 . | Mean ± SD . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age (y) | 36 | 43 | 43 | 52 | 28 | 34 | 34 | 31 | 33 | 52 | 38.6 ± 8.5 |
| Sex | Male | Female | Male | Female | Male | Male | Female | - | Female | Male | |
| Previous MS treatments | IFNb1b fingolimod | - | IFNb1a | - | IFNb1b mitoxantrone fingolimod | IFNb1a natalizumab fingolimod | IFNb1b natalizumab fingolimod | IFNb1a natalizumab fingolimod | IFNb1b natalizumab fingolimod | IFNb1a natalizumab fingolimod | |
| No. of ALZ cycles received | 1 | 2 | 2 | 3 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Cumulative ALZ dose (mg) | 60 | 96 | 96 | 132 | 60 | 60 | 60 | - | 60 | 60 | 76 ± 26 |
| Time of hemolysis to last ALZ dose (mo) | 11 | 15 | 9 | 3 | 11 | 12 | 9 | 12 | 8 | 8 | 10.3 ± 2.3 |
| Lowest haptoglobin (mg/dL)∗ | <8 | - | - | <8 | <8 | <8 | <8 | <8 | - | <8 | |
| Hb Nadir (g/dL) | 4.7 | 6.7 | 8.6 | 2.9 | 3.5 | 3.9 | 2.8 | 5.7 | 2.4 | 5.3 | 4.7 ± 2 |
| DAT (IgG/C3d) | IgG | IgG/C3d | IgG/C3d | IgG/C3d | IgG/C3d | IgG | IgG/C3d | IgG/C3d | - | - | |
| Treatment | Transfusion CORT RTX, IVIG, Cy | CORT | Folic acid Vit B12 | Transfusion CORT | Transfusion CORT IVIG, RTX | Transfusion CORT, IVIG | Transfusion CORT, PLEX | Transfusion CORT, PLEX, RTX | Transfusion CORT, IVIG, Cy, PLEX | CORT, PLEX | |
| Time to complete hematological recovery (wk) | 6 | 16 | 8 | 8 | 8 | 4 | - | 13 | - | 16 | 9.6 ± 4.8 |
| Outcome | Alive | Alive | Alive | Alive | Alive | Alive | Dead | Alive | Dead | Alive | |
| Other concomitant autoimmune effects | ITP | Grave disease | ITP | - | - | Autoimmune nephropathy | ITP | Relapsed MS | DNL | DAH, nephropathy |
| Features . | Case A (present case) . | Case B (CARE MS I trial)8 . | Case C (CARE MS II trial)16 . | Case D (CARE MS extension trial)9> . | Case E(Meunier et al)10 . | Case F (Di Ioia et al)11 . | Case G(Rieckmann et al)12 . | Case H (Tzartos et al)14 . | Case I (Metz et al)13 . | Case J(Alnahdi et al)15 . | Mean ± SD . |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age (y) | 36 | 43 | 43 | 52 | 28 | 34 | 34 | 31 | 33 | 52 | 38.6 ± 8.5 |
| Sex | Male | Female | Male | Female | Male | Male | Female | - | Female | Male | |
| Previous MS treatments | IFNb1b fingolimod | - | IFNb1a | - | IFNb1b mitoxantrone fingolimod | IFNb1a natalizumab fingolimod | IFNb1b natalizumab fingolimod | IFNb1a natalizumab fingolimod | IFNb1b natalizumab fingolimod | IFNb1a natalizumab fingolimod | |
| No. of ALZ cycles received | 1 | 2 | 2 | 3 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Cumulative ALZ dose (mg) | 60 | 96 | 96 | 132 | 60 | 60 | 60 | - | 60 | 60 | 76 ± 26 |
| Time of hemolysis to last ALZ dose (mo) | 11 | 15 | 9 | 3 | 11 | 12 | 9 | 12 | 8 | 8 | 10.3 ± 2.3 |
| Lowest haptoglobin (mg/dL)∗ | <8 | - | - | <8 | <8 | <8 | <8 | <8 | - | <8 | |
| Hb Nadir (g/dL) | 4.7 | 6.7 | 8.6 | 2.9 | 3.5 | 3.9 | 2.8 | 5.7 | 2.4 | 5.3 | 4.7 ± 2 |
| DAT (IgG/C3d) | IgG | IgG/C3d | IgG/C3d | IgG/C3d | IgG/C3d | IgG | IgG/C3d | IgG/C3d | - | - | |
| Treatment | Transfusion CORT RTX, IVIG, Cy | CORT | Folic acid Vit B12 | Transfusion CORT | Transfusion CORT IVIG, RTX | Transfusion CORT, IVIG | Transfusion CORT, PLEX | Transfusion CORT, PLEX, RTX | Transfusion CORT, IVIG, Cy, PLEX | CORT, PLEX | |
| Time to complete hematological recovery (wk) | 6 | 16 | 8 | 8 | 8 | 4 | - | 13 | - | 16 | 9.6 ± 4.8 |
| Outcome | Alive | Alive | Alive | Alive | Alive | Alive | Dead | Alive | Dead | Alive | |
| Other concomitant autoimmune effects | ITP | Grave disease | ITP | - | - | Autoimmune nephropathy | ITP | Relapsed MS | DNL | DAH, nephropathy |
ALZ, Alemtuzumab; CORT, corticosteroids; Cy, cyclophosphamide; DAT, direct antiglobulin test; DNL, disseminated necrotizing leukoencephalopathy; DAH, diffuse alveolar hemorrhage; Hb, hemoglobin; IFN, interferon; IVIG, intravenous immunoglobulin; PLEX, plasma exchange; RTX, rituximab; Vit, vitamin.
Normal range, 30 to 200 mg/dL.