Progress in the treatment of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation

Abstract

Autoimmune hemolytic anemia (AIHA) is not a rare complication of allogeneic hematopoietic stem cell transplantation (HSCT) , the incidence of AIHA after HSCT ranges between about 1﹪ to 6﹪. Different from common AIHA, the pathogenesis of AIHA after HSCT is not completely clear, which may be related to immune dysregulation after HSCT. Risk factors include young age, non-malignant disease, use of unrelated donors, haploidentical transplant, cord blood transplantation, T-cell depletion and presence of chronic graft-versus-host disease (GvHD) . As a first-line therapy, steroids often have limited therapeutic effects and are difficult to sustain remission. Therefore, they often need a combination of rituximab, large dose of immunoglobulins, even need to further joint immunosuppressive agents such as mycophenolate mofetil, cyclophosphamide, sirolimus, alemtuzumab, eculizumab, proteasome inhibitors bortezomib and so on. Some patients receive plasma exchange, occasionally splenectomy. The overall prognosis is significantly worse than primary AIHA, and the total mortality of AIHA after HSCT is often up to 50﹪. This review aims to summarize the latest treatment progress of AIHA after HSCT for clinicians' reference. Key words: Hemopoietic stem cell transplantation; Autoimmune hemolytic anemia; Treatment