Clinical analysis of 20 patients with non-Hodgkin lymphoma and autoimmune hemolytic anemia

Abstract

Non-Hodgkin lymphoma (NHL) can co-exist with autoimmune hemolytic anemia (AIHA), a phenomenon known as AIHA-associated NHL (AIHA/NHL). However, few studies have reported AIHA/NHL incidence or its clinical characteristics. We conducted a retrospective analysis of 20 AIHA/NHL patients treated at our hospital from 2009 to 2018. AIHA/NHL was presented by only 0.91% of the NHL and 9.8% of the AIHA patients. In addition, AIHA occurred most frequently with angioimmunoblastic T-cell lymphoma (AITL) (7.31%), followed by marginal zone B-cell lymphoma (MZBL) (6.25%), B-cell lymphoma-unclassified (BCL-U) (4.25%), chronic lymphocytic leukemia/small lymphocyte lymphoma (CLL/SLL) (2.50%), and mantle cell lymphoma (MCL) (2.30%). In addition to the CLL/SLL patients with impaired bone marrow, 66.7% of the AIHA/NHL patients had lymphoma bone marrow infiltration (LBMI), of which 4 patients presented LBMI in bone marrow smears (BMS) but not in bone marrow biopsy (BMB) and 6 were positive for BMB but not BMS. The 1-, 3- and 5-year survival rates of AIHA/NHL patients were 70%, 30% and 20%, respectively, and they responded poorly to chemotherapy. In conclusion, AIHA can co-exist with various NHLs and the defining clinical characteristic of AIHA/NHL is the high incidence of LBMI. However, both BMS and BMB should be performed to avoid missed diagnosis.

“Immune Hemolytic Anemia in Patients with Lymphoid Malignancy in Tanzania”

“…Similarly, the present study reports prevalence of 14% for HL but other studies reported that IHA is rare among HL. However, sample size for lymphomas was small and also our patients present at late stage of the disease which is a risk factor of developing AIHA in hematological malignancy as explained by Ji Cheng et al (15). The same as others wherever these conditions develop AIHA, the prognosis is poor (16)(17) but our study did not assess the survival rate as it was cross sectional study.…”

Immune Hemolytic Anemia in Patients with Lymphoid Malignancy in Tanzania

“…Similarly, the present study reports prevalence of 14% for HL but other studies reported that IHA is rare among HL. However, our sample size for lymphomas was small and also our patients present at late stage of the disease which is a risk factor of developing AIHA in hematological malignancy as explained by Ji Cheng et al (15). The same as others wherever these conditions develop AIHA, the prognosis is poor (16)(17) but our study did not assess the survival rate as it was cross sectional study.…”

Marginal zone lymphoma presenting in a patient with autoimmune hemolytic anemia: a case report

“…The frequency of AIHA accompanying MZL has been reported as 10% and may be associated with chronic antigen stimulation and autoantibody formation. 2 In the study conducted by Zhou et al 2 in 2020, 11 of 20 patients were followed up with AIHA before diagnosing lymphoma, while 8 were complicated with AIHA during non-Hodgkin lymphoma only one patient was diagnosed with AIHA and lymphoma simultaneously. It has been reported that 2 of these 20 patients belong to the MZL subgroup.…”

“…It has been reported that 2 of these 20 patients belong to the MZL subgroup. 2 In the article published by Hauswirth et al 7 , 10 patients with MZL were discussed, and remission was observed after splenectomy in 7 patients and after rituximab treatment in 2 patients. At the same time, only 1 of them responded to steroid treatment.…”

“…1 Secondary AIHA can usually be seen in lymphoproliferative diseases, measles, EBV and CMV infection, leukaemia, thymoma, and colon cancer. 2 The lymphoproliferative illness is the most common B-cell chronic lymphocytic leukaemia relationship, but the prevalence in other non-Hodgkin's lymphoma is lower. 3 One of these lymphomas is marginal zone lymphoma (MZL).…”