What is the treatment for Warm Autoimmune Hemolytic Anemia (WAHA)?

From the Guidelines

The primary treatment for Warm Autoimmune Hemolytic Anemia (WAHA) is glucocorticoids, which should be initiated as first-line therapy, with second-line options including splenectomy, intravenous immunoglobulins, and/or immunosuppressive therapy. The treatment approach for WAHA focuses on reducing autoantibody production and providing supportive care when necessary. According to the guidelines for the diagnosis and treatment of chronic lymphocytic leukemia, which includes recommendations for managing autoimmune hemolytic anemia 1, initial treatment with glucocorticoids is advised, rather than chemotherapy, for patients with CLL who develop AIHA or ITP. Key considerations in the management of WAHA include:

• First-line therapy with glucocorticoids, such as prednisone, to suppress the immune response and reduce hemolysis
• Second-line treatment options for patients who do not respond adequately to steroids, which may include splenectomy to remove the primary site of red blood cell destruction, intravenous immunoglobulins, or immunosuppressive agents like cyclosporine A, azathioprine, or low-dose cyclophosphamide, as suggested by the guidelines 1
• The potential use of antibody therapy, such as rituximab or alemtuzumab, for good responses in some patients, as noted in the guidelines 1
• Supportive care, including transfusions for severe anemia and folic acid supplementation to support erythropoiesis, as part of the overall management strategy.

From the Research

Treatment Options for Warm Autoimmune Hemolytic Anemia (WAHA)

• The first-line treatment for WAHA is corticosteroids, which are effective in 70-85% of patients 2, 3, 4.
• For refractory or relapsed cases, the choice of second-line treatment is between splenectomy (effective in approximately 70% of cases) and rituximab (effective in approximately 70-90% of cases) 2, 3, 4.
• Other treatment options for WAHA include:
  • Intravenous immunoglobulins (IVIGs) 5, 2, 3, 4.
  • Immunosuppressive drugs such as azathioprine, cyclophosphamide, cyclosporin, and mycophenolate mofetil 2, 3, 4.
  • Danazol 2, 3, 4.
  • Plasma-exchange 5, 3, 4.
  • Alemtuzumab and high-dose cyclophosphamide as last resort options 3, 4.
• Therapeutic plasma exchanges (TPEs) combined with low doses of IVIG may be considered as a therapeutic option in patients with severe WAHA without response to corticosteroid and IVIG treatment 5.
• Rituximab may be used instead of splenectomy in therapy-refractory patients 6.