Sirolimus in the Treatment of Refractory/Relapsed wAIHA

Peking Union Medical College Hospital22 enrolled

Overview

Autoimmune hemolytic anemia (AIHA) is a rare and heterogeneous disorder characterized by the destruction of red blood cells through warm or cold antibodies. Glucocorticoid (combined with rituximab) is the first-line treatment. However, the recurrence rate is very high and some patients may not respond to steroids. Second-line therapies include cyclosporine A (CsA), cyclophosphamide, rituximab, azathioprine, and even splenectomy. Our previous study of sirolimus in refractory/relapsed AIHA and ES found an effective rate of 80%. Therefore, the investigators plan to explore the efficacy and safety of sirolimus in the treatment of refractory/relapsed wAIHA.

Based on the optimal autoantibody-RBC reactivity temperatures, AIHA is classified into warm type, cold type, and mixed type. AIHA can be further classified into primary or secondary in nature. Glucocorticoid (combined with rituximab) is the first-line treatment. However, the recurrence rate is very high and some patients may not respond to steroids. Second-line therapies include cyclosporine A (CsA), cyclophosphamide, rituximab, azathioprine, and even splenectomy. The refractory/relapsed wAIHA patients have increased cardiovascular events, increased opportunities for infections, decreased quality of life, and even death. A prospective multi-institutional trial in autoimmune cytopenia found that 8 of 10 patients with AIHA and Evans syndrome respond to sirolimus. Our previous study of sirolimus in refractory/relapsed AIHA and ES also found an effective rate of approximately 80%. Since sirolimus is cheap and accessible, our findings may reduce the economic burden of patients and be a guide on the selection of second-line treatment drugs in refractory/relapsed wAIHA and Evans syndrome.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Eligibility

Sex: ALLMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age ≥18 years old. 2. Diagnosed as primary warm autoimmune hemolytic anemia or Evans syndrome (primary or secondary). There is no treatment indication of other systemic involvement in the original disease if secondary. 3. No response to glucocorticoid therapy or recurrence. 4. Baseline liver (ALT, AST) was less than 2 times the normal value. 5. No active infection; Not pregnant or breastfeeding. 6. Agree to sign the consent form. Exclusion Criteria: 1. Patients with connective tissue disease or other organs involvement 2. Infection or bleeding that cannot be controlled by standard treatment. 3. Active HIV, HCV or HBV infection or cirrhosis or portal hypertension. 4. Progressed uncontrolled malignant tumors and lymphoma 5. Cirrhosis or portal hypertension. 6. Pregnant or breastfeeding.

Outcomes

Primary Outcomes

Overall response rate (ORR) and complete response rate (CRR)

ORR defined as the proportion of patients who met the criteria of either complete response (CR) or partial response (PR).

Time frame: 3,6,12 months

Secondary Outcomes

Number of participants with treatment-related adverse events and the number of relapses

Time frame: 12 months, end of the follow-up

Adverse events

Safety analyses include assessments of the incidence and severity of adverse events; all adverse events that occurred or worsened during the treatment period will be reported, as well as adverse events that occurred later but are considered by the investigator to be related to the trial drug.

Time frame: 3,6,12 months

Relapse rate

Relapse rate defined as the proportion of patients whose response shift from PR or CR to no response (NR).

Time frame: 3,6,12 months

Sirolimus in the Treatment of Refractory/Relapsed wAIHA

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes