The impact of autoimmune cytopenias on the clinical course and survival of Hodgkin lymphoma.

Abstract

The characteristics of autoimmune cytopenias (AICP) associated with Hodgkin lymphoma (HL) are not thoroughly defined. We retrospectively assessed the clinical features of HL-associated AICPs in 563 HL patients diagnosed over a period of 28years. We identified 8 cases of autoimmune hemolytic anemia (AIHA) and 8 cases of autoimmune thrombocytopenia among 14 patients altogether. Four (26%) AICPs were present at lymphoma diagnosis, while 11 (74%) cytopenias occurred during follow-up after first-line therapy. The overall incidence of HL-associated AICPs was 2.8%. Nine (75%) cytopenias responded to intravenous steroids. Seven (46%) AICPs led to the diagnosis of HL, indicated a relapse, or revealed secondary malignancies. AIHAs and AICPs altogether were more likely to develop in patients with advanced-stage HL (p = 0.010 and p < 0.004, respectively). HL patients experiencing AICPs had an increased short-term (1-year) mortality compared to the general HL population (p < 0.022). The 5-year OS of HL patients with concurrent AICPs at diagnosis was inferior compared to HL patients developing AICPs during follow-up (p = 0.005), and to HL patients without AICPs (p < 0.001). Patients with HL-associated AICPs appear to have a particular disease-related profile. The association of HL and AICPs may increase short-term mortality, while patients with concurrent AICPs at HL diagnosis have a dismal prognosis.