Immune tolerance protocols using low-dose factor VIII: A review of the literature

Low-dose immune tolerance protocols use doses of factor VIII of less than 5 0 IU/kg/day to induce immune tolerance. Such protocols are chosen for a var iety of reasons including cost, patient acceptability and ease of administr ation. Early published reports of low-dose protocols appeared in 1981, desc ribed small numbers of patients and moderate success, It was proposed that such protocols might modify inhibitor responses from high to low. Later rep orts are sparse and clinical success is again moderate. Useful treatment an d expectation guidelines have emerged from experience with these protocols, and improvements for patients with inhibitors can be achieved. Considerati on of immunological success, however, raises doubts about whether real immu ne tolerance is achieved with such protocols.