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Immune tolerance induction and the treatment of hemophilia. Malmo protocol update

Berntorp, Erik LU ; Astermark, Jan LU and Carlborg, E (2000) In Haematologica 85(10 Suppl). p.48-48
Abstract
The Malmo protocol for immune tolerance induction includes high doses of Factor VIII/IX, intravenous IgG and cyclophosphamide. If the inhibitor titer exceeds 10 Bethesda units at start, extracorporeal adsorption of IgG is performed using protein A. The protocol sometimes has to be repeated. A successful response may occur within a few weeks. In hemophilia A the success rate so far is 10/17 patients (15 high-responders, 2 low-responders) or 59%, whereas in hemophilia B 6/9 patients (8 high-responders, 1 low-responder), or 67%, have become tolerant. In one hemophilia B patient, a relapse occurred after 6 months. During a second treatment episode he developed an acute myocardial infarction, probably caused by replacement with prothrombin... (More)
The Malmo protocol for immune tolerance induction includes high doses of Factor VIII/IX, intravenous IgG and cyclophosphamide. If the inhibitor titer exceeds 10 Bethesda units at start, extracorporeal adsorption of IgG is performed using protein A. The protocol sometimes has to be repeated. A successful response may occur within a few weeks. In hemophilia A the success rate so far is 10/17 patients (15 high-responders, 2 low-responders) or 59%, whereas in hemophilia B 6/9 patients (8 high-responders, 1 low-responder), or 67%, have become tolerant. In one hemophilia B patient, a relapse occurred after 6 months. During a second treatment episode he developed an acute myocardial infarction, probably caused by replacement with prothrombin complex concentrate. We conclude that the Malmo protocol is efficient for induction of immune tolerance but the patients must be selected particularly with regard to inhibitor duration and time of last booster. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Haematologica
volume
85
issue
10 Suppl
pages
48 - 48
publisher
Ferrata Storti Foundation
external identifiers
  • pmid:11187871
  • scopus:0034302666
ISSN
1592-8721
language
English
LU publication?
yes
id
3ac1d7ff-03e7-40af-9b47-b9e7624ae77b (old id 1117533)
date added to LUP
2008-06-27 14:16:41
date last changed
2017-01-01 06:58:25
@article{3ac1d7ff-03e7-40af-9b47-b9e7624ae77b,
  abstract     = {The Malmo protocol for immune tolerance induction includes high doses of Factor VIII/IX, intravenous IgG and cyclophosphamide. If the inhibitor titer exceeds 10 Bethesda units at start, extracorporeal adsorption of IgG is performed using protein A. The protocol sometimes has to be repeated. A successful response may occur within a few weeks. In hemophilia A the success rate so far is 10/17 patients (15 high-responders, 2 low-responders) or 59%, whereas in hemophilia B 6/9 patients (8 high-responders, 1 low-responder), or 67%, have become tolerant. In one hemophilia B patient, a relapse occurred after 6 months. During a second treatment episode he developed an acute myocardial infarction, probably caused by replacement with prothrombin complex concentrate. We conclude that the Malmo protocol is efficient for induction of immune tolerance but the patients must be selected particularly with regard to inhibitor duration and time of last booster.},
  author       = {Berntorp, Erik and Astermark, Jan and Carlborg, E},
  issn         = {1592-8721},
  language     = {eng},
  number       = {10 Suppl},
  pages        = {48--48},
  publisher    = {Ferrata Storti Foundation},
  series       = {Haematologica},
  title        = {Immune tolerance induction and the treatment of hemophilia. Malmo protocol update},
  volume       = {85},
  year         = {2000},
}