Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in adults: A southern China multicenter experience

Abstract

To investigate the incidence and risk factors as well as prognosis of autoimmune hemolytic anemia (AIHA) following allogeneic hematopoietic stem cell transplantation (allo‐HSCT), a total of 1377 adult hematological malignancies at three institutions were enrolled in this study. The 3‐year cumulative incidence of AIHA was 2.2 ± 0.4%. Multivariate analysis showed that haploidentical donors (HRDs) and chronic graft vs host disease (cGVHD) were the independent risk factors for AIHA. Patients with AIHA treated initially with corticosteroids combined with cyclosporine A (CsA) had a higher complete response rate than those with corticosteroids monotherapy (66.7% vs 11.1%; P = .013). The 3‐year cumulative incidence of malignant diseases relapse was 4.4 ± 4.3% and 28.0 ± 1.3% (P = .013), treatment‐related mortality (TRM) was 8.9 ± 6.3% and 17.4 ± 1.2% (P = .431), disease‐free survival (DFS) was 56.1 ± 1.5% and 86.7 ± 7.2% (P = .011), and overall survival (OS) was 86.3 ± 7.4% and 64.1 ± 1.5% (P = .054), respectively, in the patients with AIHA and those without AIHA. Our results indicate that HRDs and cGVHD are risk factors for AIHA and corticosteroids combined with CsA are superior to corticosteroids as initial treatment for AIHA. Autoimmune hemolytic anemia does not contribute to increase TRM and could reduce the malignant diseases relapse and increase DFS.

Improved outcomes using unmanipulated haploidentical hematopoietic stem cells combined with third‐party umbilical cord blood transplantation for non‐malignant diseases in children: The experience of a single center

“…Other studies have reported that the cumulative incidence of AIHA after allo-HSCT is between 1.5% and 6%. [27][28][29] risk factor for AIHA complications. A Spain team also analyzed 4099 patients (including adults and children) and found that HLAmismatched donors and an age <15 years old were significantly related to the development of AIHA at a median of 6 months after HSCT.…”

“…In our study, ten patients developed AIHA with a cumulative incidence of 9.1%. Other studies have reported that the cumulative incidence of AIHA after allo‐HSCT is between 1.5% and 6% 27‐29 . Many researchers have investigated the high‐risk factors of AIHA after transplantation.…”

“…Many researchers have investigated the high‐risk factors of AIHA after transplantation. For example, Lv et al 27 analyzed 1377 cases of adult hematological malignancies in multi‐centers and concluded that HID and cGVHD are independent risk factors for AIHA. In another study, Kruizinga et al 28 investigated 531 children and determined that NMD and CMV reactivation were an independent risk factor for AIHA complications.…”

Autoimmune hemolytic anemia: current knowledge and perspectives

“…In approximately 50% of cases, the primary form of AIHA is diagnosed, while in other cases the autoantibodies are related to autoimmune diseases, lymphoproliferative diseases, infections (also SARS-CoV-2 infection), solid tumors or solid organ transplantation (Table 1) [3,5,12,13]. The condition is also seen in patients after allogeneic stem cell transplantation (HSCT) with increasing incidence (reaching 2-6%), severe course and a high mortality rate [14][15][16][17]. Hemolysis which occurs after drugs is known as drug-induced immune hemolytic anemia (DIIHA), and is currently classified as a secondary form of AIHA [3].…”

Pathogenesis, risk factors and therapeutic options for autoimmune haemolytic anaemia in the post‐transplant setting

“…analysed a series of 1 377 adults transplanted for malignant diseases: three‐year incidence of AIHA was 2·2%. After multivariate analysis, they identified the presence of cGVHD and haplo‐HSCT as risk factors for AIHA 25 …”