Successful Treatment of Acquired Haemophilia with FEIBA® and Retuximab®

Abstract number: P1398

Malato A, Siragusa S, Anastasio R, Bonifacio G, Lo Coco L, Abbadessa V

Few evidences are present on the best treatment for managing patients with acquired haemophilia. The efficacy of activated prothrombin complex concentrate (FEIBA®) for stopping severe bleeding has been tested but a concern regards the risk of thrombosis. Immunotherapy is often unable to eradicate auto-antibodies against FVIII; the role of Rituximab® (an anti-CD20 monoclonal antibody) in this setting is still under investigation. We report a case of a patient with unstable angina who developed severe bleeding episodes (hematoma and hemoartrosis) due to acquired hemophilia. FEIBA® was administered at a dosage from 20 to 50 UI/Kg accordingly to the bleeding episodes; steroids and cyclophosphamide were administered, but unsuccessfully. Rituximab® was therefore initiated at standard dosage (375 mg/m² i.v. once weekly for 4 consecutive weeks) determining the lack of auto-antibodies after 8 months (figure).

Our case highlights the role of FEIBA® to control bleeding without increasing the risk of thrombosis, even in this patient with unstable angina. Therapy with Rituximab® achieved a full response after 8 months, a period of time longer than previously (1–3 months) reported.