Monoclonal antibodies in the treatment of autoimmune cytopenias.

In recent years, clinical studies have been undertaken with selected monoclonal antibodies (MoAbs) in the treatment of several hematological diseases, especially in malignant disorders. However, some clinical observations indicate that MoAbs may be an important alternative for the conventional therapy of some autoimmune disorders. Two MoAbs directed against CD20 antigen (rituximab, Rituxan, Mabthera) and CD52 antigen (alemtuzumab, Campath-1H) seem to be especially useful for this purpose. Autoimmune cytopenias have been investigated in the last few years with positive preliminary results. Rituximab seems to be an effective and safe agent for the treatment of immune thrombocytopenias, autoimmune hemolytic anemia, cold agglutinin disease and pure red cell aplasia. Although the case series are small, rituximab seems to be an effective and safe agent for the treatment of these diseases. Clinical experience with alemtuzumab in patients with autoimmune cytopenias is even more limited than with rituximab. However, preliminary results indicate that further studies with this MoAb are warranted. A longer follow-up and the studies on larger number of patients are needed to determine the real value of these new approaches in autoimmune cytopenias. Recent experiences with the use of MoAbs in treatment of these diseases are the subject of this review.