Flores G, Cunningham-Rundles C, Newland A C, Bussel J B
Department of Pediatrics, New York Hospital-Cornell Medical Center, New York 10021.
Am J Hematol. 1993 Dec;44(4):237-42. doi: 10.1002/ajh.2830440404.
To determine whether warm-antibody autoimmune hemolytic anemia (AIHA) responds to treatment with intravenous gammaglobulin (IVGG), we conducted separate pilot studies at three institutions enrolling a total of 37 patients. We combined these results with a review of 36 cases of AIHA treated with IVGG reported in the literature. Sixteen clinical variables were examined to determine associations with response to IVGG. Overall, 29 of 73 patients (39.7%) responded to IVGG therapy. Two variables were strongly related to a good response to IVIG: the presence of hepatomegaly (with and without splenomegaly) and a low pre-treatment hemoglobin. A trend towards a better response was observed in the 11 children. Overall, IVGG provided acute benefit in only 1/3 of patients and therefore cannot be recommended as standard therapy for AIHA. It may, however, be useful as adjunctive treatment in selected cases, such as in those with a pre-treatment hemoglobin < 6-7 gm/dl or those with hepatomegaly, and in clinical settings where the toxicity of other treatments may be an important consideration.
为了确定温抗体型自身免疫性溶血性贫血（AIHA）对静脉注射丙种球蛋白（IVGG）治疗是否有反应，我们在三个机构开展了单独的试点研究，共纳入37例患者。我们将这些结果与文献中报道的36例接受IVGG治疗的AIHA病例回顾相结合。检查了16个临床变量以确定与IVGG反应的相关性。总体而言，73例患者中有29例（39.7%）对IVGG治疗有反应。有两个变量与对IVIG的良好反应密切相关：肝肿大（无论有无脾肿大）和治疗前血红蛋白水平低。11名儿童中观察到有更好反应的趋势。总体而言，IVGG仅对三分之一的患者有急性益处，因此不能推荐作为AIHA的标准治疗方法。然而，它可能作为辅助治疗在某些特定情况下有用，例如治疗前血红蛋白<6 - 7 g/dl的患者或有肝肿大的患者，以及在其他治疗的毒性可能是重要考虑因素的临床环境中。
