ISSN 2997-1036
International Journal of Hematology | Vol. 6, No. 11, November 2015 | pp. 81–88
DOI: 10.46882/2015/IJH/000071
Original Article
Title: Clinical features and therapeutic response to low-dose cyclophosphamide in warm autoimmune hemolytic anemia
Names of Authors: A. I. Ibrahim¹, C. D. Balogun², E. O. Ojo³
Authors’ Affiliations: ¹Department of Haematology, Ahmadu Bello University, Zaria, Nigeria; ²Department of Medicine, University of Ilorin, Ilorin, Nigeria; ³Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
Abstract: Corticosteroids serve as the standard primary intervention for warm autoimmune hemolytic anemia, but long-term maintenance can induce significant toxicity or treatment dependency. This prospective study evaluated the clinical efficacy and safety profiles of low-dose oral cyclophosphamide (50 mg to 100 mg daily) as a steroid-sparing agent in 24 adult patients with relapsed or steroid-dependent warm autoimmune hemolytic anemia. Clinical responses were determined by tracking stabilization of hemoglobin values above 10.5 g/dl without packed red cell support. Complete remission was achieved in 58.3% (14 of 24) of patients within a median window of 8 weeks, while 25.0% (6 of 24) attained a partial remission. The mean baseline hemoglobin rose from 6.4 ± 1.2 g/dl to 11.2 ± 1.4 g/dl by month 6 of therapy (P < 0.001). Concurrently, the maintenance prednisone dose was tapered by over 75.0% in responsive individuals. Mild, transient leukopenia occurred in 12.5% of the cases, but resolved without necessitating drug discontinuation. Oral cyclophosphamide represents a highly cost-effective and well-tolerated second-line protocol for sustaining remission in low-resource environments.
Keywords: Autoimmune hemolytic anemia, cyclophosphamide, prednisone, steroid-sparing agent, remission
Manuscript Timeline: Received: August 14, 2015; Revised: September 20, 2015; Accepted: October 12, 2015; Published: November 15, 2015