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Plasma exchange and rituximab treatment for lenalidomide‐associated cold agglutinin disease
Author(s) -
Brauer David L.,
Edelman Bennett,
Rapoport Aaron P.,
Hess John R.,
Akpek Görgün
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03608.x
Subject(s) - lenalidomide , medicine , cold agglutinin disease , rituximab , autoimmune hemolytic anemia , thalidomide , gastroenterology , hemolysis , immunology , hemolytic anemia , anemia , multiple myeloma , lymphoma
BACKGROUND: Lenalidomide is an amino‐substituted analog of thalidomide with potent immunomodulatory properties. The drug has been widely used for treatment of multiple myeloma and myelodysplastic syndrome (MDS) associated with 5q‐abnormality. The most common side effects are cytopenias, infections, and deep venous thrombosis. CASE STUDY: We report a clinical observation of severe autoimmune hemolytic anemia (AIHA) due to cold agglutinin disease (CAD) that developed 11 days after initiation of lenalidomide treatment in a patient with MDS who relapsed after allogeneic bone marrow transplantation. RESULTS: CAD was diagnosed by the presence of hemolytic variables and cold agglutinin detected in patient's plasma. The antibody screen, which was performed at 37°C, was negative throughout. The direct antiglobulin test was positive only for complement (C3d). These findings supported the diagnosis of CAD associated with lenalidomide administration. Other causes of hemolysis including ABO incompatibility and infectious etiologies were ruled out. Rituximab therapy in conjunction with daily plasma exchange decreased the rate of hemolysis and transfusion requirement in our case. CONCLUSION: In addition to warm AIHA, lenalidomide use can also be associated with development of CAD. Rituximab given in conjunction with plasma exchange can be effective in treating CAD in this setting.