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

Haemophilia : the Official Journal of the World Federation of Hemophilia
T BissJ Hanley

Abstract

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.

References

Jan 25, 2002·The New England Journal of Medicine·Bertrand CoiffierChristian Gisselbrecht
Oct 18, 2002·Blood·Adrian WiestnerGeraldine P Schechter
Jan 22, 2005·Haemophilia : the Official Journal of the World Federation of Hemophilia·A AggarwalG P Schechter
Feb 4, 2005·The Journal of Pediatrics·Julie WangJames B Bussel
Jan 1, 1996·Haemophilia : the Official Journal of the World Federation of Hemophilia·J Katz

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Citations

Jan 13, 2012·Genetics in Medicine : Official Journal of the American College of Medical Genetics·Yoav H MessingerPriya S Kishnani
Oct 13, 2012·Genetics in Medicine : Official Journal of the American College of Medical Genetics·Suhrad G BanugariaPriya S Kishnani
Oct 27, 2010·Expert Review of Hematology·Carol H Miao
Mar 27, 2009·Journal of Thrombosis and Haemostasis : JTH·P W CollinsUNKNOWN UK Haemophilia Centre Doctors' Organisation
Aug 2, 2008·Haemophilia : the Official Journal of the World Federation of Hemophilia·M FranchiniM Cruciani
Apr 19, 2015·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Peter KubiszIvana Plameňová

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