Fludarabine causes AIHA in husband ....Dr. Rai's RCD

[Guest guest]

Dear Terry, in regard to your answer below, could you be more specific

as to how cyclosporin gives " cover " to bendamustine? I am also SO

curious as to why you say that maybe any other treatment 's

husband has after he recovers may trigger another AIHA episode. Is

the immune system then just " turned on " and more wary? I feel this is

what has happened to me even though I got AIHA 7 years into CLL before

any treatment. It got quite a lot worse when we tried out PCR and had

to stop after one cycle when I had runaway hemolysis.

I then saw Dr. Rai and did 5 months of his RCD which helped but still

didn't completely stop hemolysis but it did seem like the best answer

for a pretty crazed immune system. I am now finishing up with the

entire 6 months of Arzerra which unfortunately is giving me some nasty

side effects like neuropathy. Hopefully that will abate when the

drug is discontinued in 4 months. It is keeping the hg up better, but

as we moved from the weekly to the once a monthly Arzerra, the hg is

dropping again. But Arzerra (or also the RCD?) has also lowered ALL

my gammaglobulins well beyond the low they were at before. Do Rituxan

and Arzerra in killing the B-cells wipe out most of the

gammaglobulins? I am thinking if the A doesn't keep the hg up, I will

probably have to try RCD again and wonder if it does some kind of

" conditioning " to the immune system that helps it go back to normal,

very unlike other combinations of chemos.

My doc was also told by Dr. Rai that he had seen Bendamustine cause

AIHA in some instances and so did not recommend it for me. And Dr.

Rai told me that he had seen people whose AIHA got worse doing PCR or

FCR, even in combination, like me. He is not in favor apparently of

using purine analogs with people dealing with AIHA. Clive Zent of

Mayo argues adamantly against using them with AIHA. Again, we are all

so different.

I hope you are hanging in there through all of what you are going

through. Best to you, all my prayers and thoughts to you, Carol

4b. Re: Fludarabine causes AHA in husband ..Dr. Hamblin?

Posted by: " TERJOHA@... " TERJOHA@... terryhamblin

Date: Thu Oct 7, 2010 5:32 pm ((PDT))

I was the one who first discovered that fludarabine caused hemolytic

anemia. It is possible that when your husband recovers almost any treatment will

retrigger another episode. In my opinion the best remedy is the Kanti Rai

regimen that involves steroids, cyclophosphamide and rituximab. He might

also find that cyclosporin is helpful. It is very unusual for FCR as opposed

to fludarabine alone to cause AIHA; in the recent German trial it was less

than 1% of cases.

Bendamustine is almost certainly contraindicated unless it is given with

cyclosporin cover. DR Byrd is an expert on fludarabin-induced AIHA and he

should be able to advise you.

Terry Hamblin MD

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