Treatment of childhood autoimmune haemolytic anaemia with rituximab

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