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Thromb Haemost 1999; 81(01): 35-38
DOI: 10.1055/s-0037-1614414
Review Article
Schattauer GmbH

Immune Tolerance Therapy for Haemophilia A Patients with Acquired Factor VIII Alloantibodies: Comprehensive Analysis of Experience at a Single Institution

M. P. Smith
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
K. J. Spence
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
E. L. Waters
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
R. Beresford-Webb
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
M. J. Mitchell
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
J. Cuttler
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
A. Alhaq
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
S. A. Brown
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
,
G. F. Savidge
1   From the Haemophilia Centre, Reference Centre for Haemostatic and Thrombotic Disorders, St Thomas’ Hospital, London, UK
› Author Affiliations
Further Information

Publication History

Received13 May 1998

Accepted after revision19 September 1998

Publication Date:
08 December 2017 (online)

Also available at
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Summary

Eleven children with severe haemophilia A associated with the IVS 22 inversion and acquired high titre neutralising antibodies to factor VIII underwent immune tolerance induction. HLA class I and high resolution class II type is detailed for each patient. A three phase approach to immune tolerance induction was used. During phase 1, which lasted a median of six weeks, patients received factor VIII 100 IU/kg twice daily. Phase 2 comprised a factor VIII dose reduction to 100 IU/kg once daily, and continued for a median duration of 14 weeks. Subsequently 10 of the 11 patients satisfied the criteria of absent factor VIII neutralising activity by the Bethesda method, and a factor VIII elimination half life of greater than 5 h, allowing progression to phase 3, a further factor VIII dose reduction to 50 IU/kg three times weekly. A model for dose reduction as factor VIII tolerance evolves, based on pharmacokinetic analysis, is described.

 

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