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Synchronization of plasma exchange and cyclophosphamide in severe and refractory autoimmune hemolytic anemia

V A Silva1, R H Seder, L R Weintraub

  • 1Blood Bank, Washington University Medical Center, St. Louis, Missouri.

Journal of Clinical Apheresis
|January 1, 1994
PubMed

Two cases of severe autoimmune hemolytic anemia (AIHA) that failed multiple treatment modalities obtained complete and long-lasting remissions with a combination of three one volume plasma exchange (PE) on succeeding days followed 6 hours later on the 3rd day by cyclophosphamide (cyc) 750 mg/m2 IV, and cyc/prednisone (pred) qd tapering to either no therapy or minimal therapy over a 6 month period. Both cases remain without evidence of AIHA after 43 and 19 months follow-up. Possible non-exclusive mechanisms that explain this favorable outcome are enhanced cytotoxic effect of cyc on proliferating lymphocytes participating in the antibody rebound phenomena, suppression of B lymphocytes with daily cyc/pred, and/or formation of anti-idiotype antibodies.

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