Treatment of childhood autoimmune haemolytic anaemia with rituximab

Autoimmune haemolytic anaemia commonly has a severe course in young childre n, thus requiring multiple immunosuppressive treatments. Five children with refractory idiopathic autoimmune haemolytic anaemia, and one child with th e disease after bone-marrow transplantation, were treated with rituximab-a monoclonal antibody against CD20. Tolerance of the treatment was good. Howe ver, circulating B cells were absent and hypogammaglobulinaemia was seen fo r 9 months after treatment. All patients remained in complete remission 15- 22 months after the start of rituximab therapy. Corticosteroids and immunos uppressive drugs were stopped or their dose markedly reduced. We suggest th at rituximab could be a valuable treatment for autoimmune haemolytic anaemi a, although a long-lasting but transient B-cell deficiency develops.