Successful treatment of refractory autoimmune haemolytic anaemia with a proteosome inhibitor: First reported case from Sri Lanka

Autoimmune haemolytic anaemia (AIHA) is a haematological disorder with an incidence of 1-3 per 100,000 individuals/ year1. Around 40%-50%of AIHA cases are idiopathic2. We present a case of AIHA in a young boy who was refractory to multiple treatment lines, but eventually achieved complete remission after treatment with the proteasome inhibitor, bortezomib. The patient was refractory to multiple lines of treatment including predni-solone, intravenous immunoglobulin (IVIg), methylprednisolone, rituximab, cyclophosphamide and mycophenolate mofetil. He eventually had a beneficial response to a proteasome inhibitor-based combination with bortezomib plus mycophenolate mofetil. The treatment of refractory AIHA can be challenging. Patients with AIHA refractory to primary or secondary treatments must resort to receiving novel therapeutic modalities including combinations targeting plasma cell, T and B-cell proliferation.