Single-dose Anti-CD20 Antibody With Bortezomib for Relapsed Refractory Autoimmune Hemolytic Anemia

  • End date
    Aug 20, 2023
  • participants needed
  • sponsor
    Peking Union Medical College Hospital
Updated on 21 October 2021
treatment regimen


Patients of relapsed and refractory warm autoimmune hemolytic anemia or EVANS syndrome aged 18 to 80 will be included in this study. The treatment regimen is a single dose anti-CD20 antibody (500mg) combined with bortezomib (1.3mg/m2 twice a week for two weeks). The treatment course would be repeated three months later.


Glucocorticoids are the first-line treatment of warm AIHA. The overall response is 70-90%, but 10% to 20% patients are refractory to GCs and more than 50% patients will relapse after GCs tapering or cessation.

Anti-CD20 monoclonal antibody is the preferred second-line treatment for relapsed refractory wAIHA. Anti-CD20 antibody 375 mg/m2, once a week, four times, is the standard treatment regimen. Low dose anti-CD20 antibody, 100mg once a week, four times, also showed similar response rate. However, the use of four times of intravenous infusion is trouble. So the investigators intend to explore the efficiency of the singe dose of 500mg anti-CD20 antibody.

Anti-CD20 antibody takes median 6-8 weeks to response and only about 50% patients achieving long-term response. Plasma cells produce antibodies and long-lived plasma cells in bone marrow and spleen continuously work. Bortezomib is a proteasome inhibitor and targets plasma cells. Bortezomib has become a first-line treatment for clonal plasma cell diseases (such as multiple myeloma, systemic amyloidosis, POEMS syndrome, etc.). Bortezomib can also induce reactive plasma cell apoptosis and has a variety of immunomodulatory effects. The investigators try to combine bortezomib with anti-CD20 antibody, which may play a synergistic role and improve the efficacy.

Patients of relapsed and refractory warm autoimmune hemolytic anemia or EVANS syndrome will receive a single dose anti-CD20 antibody (500mg) and bortezomib (1.3mg/m2 twice a week for two weeks) twice for three months interval.

Condition Primary Cold Agglutinin Disease, Evans Syndrome, Autoimmune hemolytic anemia, Autoimmune Disease, Autoimmune disease
Treatment combination of a single dose anti-CD20 antibody and bortezomib
Clinical Study IdentifierNCT04083014
SponsorPeking Union Medical College Hospital
Last Modified on21 October 2021


Yes No Not Sure

Inclusion Criteria

Diagnosis of warm autoimmune hemolytic anemia or EVANS syndrome, primary or secondary
Patients refractory to glucocorticoids (HGB increase less than 20g/L after three weeks full dose glucocorticoids treatment). Or patients relapse after at least one course of glucocorticoids therapy (HGB < 110g/L in female and HGB < 120g/L in male). Or glucocorticoids dependence (prednisone maintenance dose > 10mg a day). Or glucocorticoids intolerance
Normal heart function, liver function (total bilirubin < 1.5ULN, ALT, AST < 3.0 ULN), and renal function (serum creatinine < 1.0 ULN)
No active infection
No malignant tumors (except carcinoma in situ)
Patients understand the content of the study, participate the study and sign the informed consent voluntarily

Exclusion Criteria

Patients with malignant tumors (excluding carcinoma in situ)
With uncontrollable infections or other serious diseases
Active hepatitis B, serume HBV-DNA > 104copies/ml
Women during pregnancy or lactation
Not strict contraception
Psychiatric patients and those with severe mental illness
Other conditions that researchers consider inappropriate to join the study
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