Autoimmune hemolytic anemia (AIHA) is a rare disorder with multiple etiologies and usually presents as anemia with hemolysis. Initial treatments for AIHA include steroids and rituximab, but many patients require supportive blood transfusion therapy. Over the last few years, studies have explored bone marrow compensation since erythropoietin (EPO) levels are often low in patients with AIHA. To understand the efficacy and safety of recombinant EPO (rEPO), researchers in Italy followed a cohort of 47 patients with AIHA and inadequate reticulocytosis and erythropoietin (Hb < 10 g/dL; mean age, 69 years; 47% warm-type AIHA, 40% cold angulation disease, 13% mixed [warm and cold]) and evaluated hematologic parameters over 12 months. Along with standard treatment, patients were given 40,000 IU of rEPO each week until hemoglobin levels were above 11 g/dL. After just 15 days, the overall response rate was 55% and had reached 91% by 12 months. In addition, hemoglobin values increased significantly from +1.4 at 15 days to +4.4 g/dL at 12 months, and the transfusion needs of patients were reduced from 30% to <10% after just 15 days. Compared to a cohort treated with standard of care (n=43), patients given rEPO had significantly higher overall response rates (Hb >12 g/dL and normalization of hemolytic parameters) by day 15 (32% vs 55%, respectively). While adverse events were similar in both groups, further randomized studies are needed on the benefits of treating patients with AIHA with rEPO.
References:
- Fattizzo B, GL Pedone, C Brambilla, L Pettine, et al. Recombinant erythropoietin in autoimmune hemolytic anemia with inadequate bone marrow response: a prospective analysis. Blood Adv 2024; 8 (5): 1322–1327.
- MM Moser and B Jilma; Add-on erythropoietin in autoimmune hemolytic anemia. Blood Adv2024; 8 (5): 1320–1321.
