Autoimmune hemolytic anemia and autoimmune thrombocytopenia at diagnosis and during follow-up of Hodgkin lymphoma

Abstract

Autoimmune hemolytic anemia and thrombocytopenia (AIHA/AITP) frequently complicate the course of non-Hodgkin lymphomas, especially low-grade, but they are very rarely observed in Hodgkin lymphoma (HL). Consequently the frequency and the profile of patients with HL-associated AIHA/AITP have not been well defined. Among 1029 patients with HL diagnosed between 1990 and 2010, two cases of AIHA (0.19%) and three of AITP (0.29%) were identified at the presentation of disease. These patients were significantly older, and more frequently had features of advanced disease and non-nodular sclerosing histology, compared to the majority of patients, who did not have autoimmune cytopenias at diagnosis. ABVD combination chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) provided effective control of HL and the autoimmune condition as well. During approximately 6600 person-years of follow-up for the remaining 1024 patients, seven (0.7%) patients developed autoimmune cytopenias (three AITP, three AIHA, one autoimmune pancytopenia) for a 10- and 15-year actuarial incidence of 0.95% and 1.40%, respectively. Their features did not differ compared to the general population of adult HL. In this large series of consecutive, unselected patients, those who presented with autoimmune cytopenias had a particular demographic and disease-related profile. In contrast, patients developing autoimmune cytopenias during follow-up did not appear to differ significantly from those who did not.

Prognostic significance of CD20 expression and Epstein‐Barr virus (EBV) association in classical Hodgkin lymphoma in Japan: A clinicopathologic study

“…B symptoms (unexplained fever, night sweats, or weight loss) are associated with increased plasma levels of cytokines such as IL‐6 which is reported to be associated with inferior survival in Hodgkin lymphoma patients . Possible etiologies of thrombocytopenia during the course of the disease include the toxic effects of chemotherapy regimens, therapy‐related myelodysplastic syndrome, heavy bone marrow infiltration and/or hypersplenism in patients with relapsed/refractory disease . Elevated serum LDH reflects tumor burden and cellular turnover in several malignancies, including germ cell tumors, sarcomas and non‐Hodgkin lymphoma.…”

“…23 Possible etiologies of thrombocytopenia during the course of the disease include the toxic effects of chemotherapy regimens, therapy-related myelodysplastic syndrome, heavy bone marrow infiltration and/or hypersplenism in patients with relapsed/refractory disease. 24 Elevated serum LDH reflects tumor burden and cellular turnover in several malignancies, including germ cell tumors, sarcomas and non-Hodgkin lymphoma. Therefore, it has been recognized as a poor prognostic factor and as a tumor marker.…”

Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting

“…The risk factors for chronic AIHA include underlying autoimmune (especially SLE) and lymphoproliferative disorders. While there is a high association of AIHA with non-Hodgkin lymphoma, especially CLL, AIHA is rare in patients with Hodgkin's lymphoma [24]. Allogeneic hematopoietic stem cell transplantation (HSCT) may also increase the risk for AIHA.…”

Autoimmune Hemolytic Anemia and Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Association

“…AIHA is the most common autoimmune syndrome found in association with lymphoid malignancy. AIHA prevalence is about 5% to 10% of chronic lymphocytic leukemia (CLL) [3–5], 2% to 3% of non-Hodgkin lymphoma [2], and 0.1% to 1% of classical Hodgkin lymphoma (cHL) [2, 6, 7]. In the latter context, most of the patients have mixed-cellularity HL, and all patients with concurrent AIHA and cHL have advanced disease [6].…”