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Blood, 15 March 2005, Vol. 105, No. 6, pp. 2287-2293. Prepublished online as a Blood First Edition Paper on November 12, 2004; DOI 10.1182/blood-2004-05-1811. This Article Full Text (PDF) All Versions of this Article: 2004-05-1811v1 105/6/2287    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Zeitler, H. Articles by Brackmann, H.-H. Search for Related Content PubMed PubMed Citation Articles by Zeitler, H. Articles by Brackmann, H.-H. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted May 11, 2004 Accepted November 5, 2004 Treatment of acquired hemophilia by the Bonn-Malmo Protocol: documentation of an in-vivo immunomodulating concept Heike Zeitler*, Gudrun Ulrich-Merzenich, Lothar Hess, Eligius Konsek, Christoph Unkrig, Peter Walger, Hans Vetter, and Hans-Hermann Brackmann Medical Policlinic of the University of Bonn, Bonn, Germany Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany Federal Institute for Pharmaceuticals and Medicinal Products (BfARM), Bonn, Germany * Corresponding author; email: heike.zeitler{at}uni-bonn.de. Acquired hemophilia (AH) is an extremely rare condition in which auto-antibodies (inhibitors) against clotting Factor VIII induce acute and life-threatening hemorrhagic diathesis due to abnormal blood clotting. The mortality rate of AH is as high as 16% and current treatment options are associated with adverse side effects. We investigated a therapeutic approach for AH called the modified Bonn Malmoe Protocol (MBMP). The aims of MBMP include suppression of bleeding, permanent elimination of inhibitors, and development of immune tolerance, thereby avoiding long-term reliance on coagulation products. The protocol included: 1) immunoadsorption for inhibitor elimination, 2) Factor VIII substitution, 3) intravenous immunoglobulin, and 4) immunosuppression. Thirty-five high-titer patients with critical bleeding that underwent MBMP were evaluated. Bleeding was rapidly controlled during 1 or 2 apheresis sessions and no subsequent bleeding episodes occurred. Inhibitor levels decreased to undetectable levels within a median of 3 d (95% CI, 2-4 d), factor substitution was stopped within a median of 12 d (95% CI, 11-17 d), and treatment was completed within a median of 14 d (95% CI, 12-17 d). Long-term follow-up (7 mo-7 y) showed an overall response rate of 88% for complete remission (CR). When cancer patients were excluded, the CR rate was 97%. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: A. Huth-Kuhne, F. Baudo, P. Collins, J. Ingerslev, C. M. Kessler, H. Levesque, M. E. M. Castellano, M. Shima, and J. St-Louis International recommendations on the diagnosis and treatment of patients with acquired hemophilia A Haematologica, April 1, 2009; 94(4): 566 - 575. [Abstract] [Full Text] [PDF] M. Franchini and G. Lippi Acquired factor VIII inhibitors Blood, July 15, 2008; 112(2): 250 - 255. [Abstract] [Full Text] [PDF] Y. Alvarado, Xin Yao, C. Jumper, F. Hardwicke, N. D'Cunha, and E. Cobos Acquired Hemophilia: A Case Report of 2 Patients With Acquired Factor VIII Inhibitor Treated With Rituximab Plus a Short Course of Steroid and Review of the Literature Clinical and Applied Thrombosis/Hemostasis, October 1, 2007; 13(4): 443 - 448. [Abstract] [PDF] C. M. Kessler New Perspectives in Hemophilia Treatment Hematology, January 1, 2005; 2005(1): 429 - 435. [Abstract] [Full Text] [PDF]

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