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Failure of rituximab to induce immune tolerance in a boy with severe haemophilia A and an alloimmune factor VIII antibody: a case report and review of the literature
Author(s) -
BISS T. T.,
VELANGI M. R.,
HANLEY J. P.
Publication year - 2006
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.2006.01212.x
Subject(s) - rituximab , medicine , haemophilia a , antibody , immunology , haemophilia , cd20 , immune tolerance , haemophilia b , titer , immune system , pediatrics
Summary. We report the use of rituximab (MabThera ® ; Roche Grenzach‐Wyhlen, Germany) in a 6‐year‐old boy with severe haemophilia A and a high titre alloimmune factor VIII (FVIII) antibody, which had failed to respond to standard immune tolerance therapy. Rituximab was administered in 4 weekly doses with concurrent high‐dose i.v. immunoglobulin (Flebogamma ® ; Grifols, Barcelona, Spain) followed by daily high‐dose recombinant FVIII concentrate (Recombinate ® ; Baxter, CA, USA). Despite a fall in CD20 positive cell count to undetectable levels the inhibitor persisted. We discuss the possible reasons for failure of immune tolerance induction and review the literature concerning the use of rituximab for this indication.