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Treatment Options |
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SPECIAL NOTE:
Please be aware that all treatments, including blood transfusions, can
have side effects, some known and others yet to be discovered.
With CAD, no treatment is usually necessary when the patient's degree of anemia is mild. Blood checks are essential as well as a daily dosage of folic acid and avoidance of exposure to cold. Procrit (Epogen, erythropoetin ) injections are sometimes successful in raising hemoglobin levels in some CAD patients. Splenectomy is usually effective in helping warm agglutinins but is an ineffective therapy for CAD. Prior to the use of rituximab (see below), corticosteroids and immunosuppressive treatments, alkylating agents, and interferon have been used, with short-lived results and undesirable side effects. Blood transfusions of washed red cells are sometimes necessary as a temporary measure when the hemoglobin gets very low - 7 or lower and the antibody titer is high. The blood should be warmed to prevent new red cells from being coated with antibodies. Plasma exchange (plasmapheresis), which involves filtering blood to remove antibodies, is sometimes helpful when other treatments fail. This too is a short-lived measure. Rituximab (RituxanŽ or MabtheraŽ) is currently the treatment of choice. A round of treatment is normally four infusions that are given one per week for 4 weeks. Sometimes a second round of four infusions is prescribed. There is a risk with the initial dose due to the possibility of a serious allergic reaction. Medical facilities are well aware of this and take special precautions prior to the infusion. Rituximab is a single agent monoclonal antibody designed to kill off the B-cells which make the antibodies that destroy the red cells. With the destruction of B-cells, the hemoglobin rises. In time, in most cases, the number of B-cells will again increase and it may become necessary to retreat with rituximab or another single agent monoclonal antibody. We three, who have created this website, have been treated with rituximab with good results to date. Jane - 7 years, Graeme - 6 years, Betty - Rituxan X 8 in 2006 and retreated with another 8 in 2010 One can have side-effects including fatigue following Rituxan. Please read the Stories Pages. Rituximab plus oral Cytoxan/Sendoxan (cyclophosphamide) and other immunosuppressive drugs are used in combination for some stubborn cases.
Rituximab plus oral fludarabine See our Links Page "High Response Rate and Durable Remissions Following Fludarabine and Rituximab Combination Therapy for Chronic Cold agglutinin Disease" where you can download this report. There are potential side effects which need to be taken into account by your medical practitioner. Doctor Berentsen has said "As you will read, it is a considerably more aggressive therapy than Rituximab single agent and, therefore, potentially more toxic; and we will be cautious in using it in very old and frail patients (e.g., people over 80-85 suffering from other diseases at the same time)." In the U.S., the research is being done through the NIH.
Retreatment According to recent published reports, there are several new single agent drugs like Rituxan which are either in clinical trials or have been approved for use in Non-Hodgkins Lymphoma, Multiple Myeloma, Chronic Lymphocytic Leukemia, Rheumatoid Arthritis, Lupus and other autoimmune diseases and may have application for CAD
CMV
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