CD5-negative chronic lymphocytic leukemia with indolent clinical course and autoimmune thrombocytopenia, successfully treated with rituximab

Autoimmune complications in chronic lymphocytic leukaemia (CLL)

Patients with B-chronic lymphocytic leukaemia /small lymphocytic lymphoma (CLL) have a 5-10% risk of developing autoimmune complications, which primarily cause cytopaenia. These autoimmune cytopaenias can occur at any stage of CLL and do not have independent prognostic significance. The most common autoimmune complication is autoimmune haemolytic anaemia with a lower frequency of immune thrombocytopaenia and pure red blood cell aplasia and only rarely, autoimmune granulocytopaenia (AIG). Autoimmune cytopaenia should always be considered in the differential diagnosis of cytopaenia in patients with CLL. Patients with CLL can also have more than one form of autoimmune cytopaenia, which can occur together with bone-marrow failure. Treatment is usually effective but rarely curative for autoimmune cytopaenia complicating CLL. Optimal therapy will depend on a timely and accurate diagnosis of autoimmune cytopaenia and should be individualised according to the severity of the cytopaenia and the presence or absence of concomitant progressive CLL requiring therapy.

The successful treatment of refractory autoimmune hemolytic anemia with rituximab in a patient with chronic lymphocytic leukemia

The most frequent autoimmune complication in chronic lymphocytic leukemia (CLL) is autoimmune hemolytic anemia (AIHA). There are various treatment modalities; however, there is not much experience with the use of the chimeric anti-CD20 monoclonal antibody rituximab in the autoimmune complications of CLL. Here, we present our patient with CLL and AIHA whose AIHA was unresponsive to various treatment modalities. The administration of 375 mg/m(2)/day rituximab weekly for four cycles halted hemolysis and resulted in resolution of the patient's anemia. One year after therapy, the patient is well with a normal blood count. Rituximab might be preferred over other treatment modalities in the autoimmune complications of CLL because it is effective and has fewer side effects than other therapies.