Treatment of
steroid refractory
autoimmune hemolytic anemia (AIHA) is challenging especially with no evidence based consensus guide lines and limited resources. The aim of this study was to evaluate the efficacy of pulse
cyclophosphamide therapy in patients with severe refractory warm AIHA. The prospective study was designed to evaluate the efficacy of pulse
cyclophosphamide-1 g/month for four consecutive months-in 17 patients (10 males and 7 females) with severe refractory warm AIHA [13 primary AIHA and 4 (females) secondary to SLE], all studied patients failed to respond to high dose of
steroid therapy ± azathioprine ± intravenous immunoglobulin ± oral
cyclophosphamide. Mean
hemoglobin level, reticulocytic count and direct antiglobulin test were assessed before and after
cyclophosphamide treatment every month. After the 4th cycle of
cyclophosphamide (82 %, 14 patients) achieved partial response while the remaining (17 %, 3 patients) showed no response, while after 6 months follow up 47 % (8 patients) show complete response, while 53 % (9 patients) showed partial response. The mean
hemoglobin levels were significantly increased after the 1st, 2nd, 3rd and 4th months of pulse
cyclophosphamide therapy when compared to before treatment (P < 0.01, P < 0.001, P < 0.001 and P < 0.001) respectively, and the mean reticulocyte (%) were significantly decreased after the 2nd, 3rd and 4th months (P < 0.05, P < 0.01 and P < 0.001) respectively. We conclude that pulse
cyclophosphamide therapy is well tolerated and induces good response in patients with severe refractory warm AIHA.