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.
Highlights
Autoimmune hematological diseases (AHDs) have been reported to occur more frequently than other autoimmune complications after allogeneic hematopoietic stem cell transplantation.[1-8]
This study mainly focused on the incidence and risk factors of autoimmune hemolytic anemia (AIHA), treatment response, treatment‐related mortality (TRM), malignant diseases relapse, disease‐free survival (DFS), and overall survival (OS)
Relapse of malignant diseases was defined by reappearance of blasts in the peripheral blood, recurrence of bone marrow (BM) blasts >5%, or development of extramedullary disease infiltrates at any site
Summary
Autoimmune hematological diseases (AHDs) have been reported to occur more frequently than other autoimmune complications after allogeneic hematopoietic stem cell transplantation (allo‐HSCT).[1-8]. Autoimmune hematological diseases may affect a single lineage of blood cells, for example, autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), or 2 and/or 3 lineages, for example, Evans syndrome. In these AHDs, AIHA is the most common with estimates of the incidence between 2% and 6%7,9-11 in recipients of allo‐HSCT. We retrospectively analyzed the incidence and risk factors, and the outcomes of corticosteroids combined with cyclosporine A (CsA) or corticosteroids monotherapy as initial treatment in the patients developed AIHA after allo‐HSCT Corticosteroids are usually used as first‐line treatment for AIHA, but the effective rate is approximately 10%‐40% in patients with AIHA posttransplants.[3,10,17,18] In our multicenter report, we retrospectively analyzed the incidence and risk factors, and the outcomes of corticosteroids combined with cyclosporine A (CsA) or corticosteroids monotherapy as initial treatment in the patients developed AIHA after allo‐HSCT
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