Immunotherapy-associated Autoimmune Hemolytic Anemia

Steven R Hwang; Antoine N Saliba; Alexandra P Wolanskyj-Spinner

doi:10.1016/j.hoc.2021.11.002

Immunotherapy-associated Autoimmune Hemolytic Anemia

Hematol Oncol Clin North Am. 2022 Apr;36(2):365-380. doi: 10.1016/j.hoc.2021.11.002.

Authors

Steven R Hwang¹, Antoine N Saliba¹, Alexandra P Wolanskyj-Spinner²

Affiliations

¹ Division of Hematology, Department of Medicine, Mayo Clinic, 200 First street Southwest, Rochester, Minnesota 55905, USA; Division of Medical Oncology, Department of Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA.
² Division of Hematology, Department of Medicine, Mayo Clinic, 200 First street Southwest, Rochester, Minnesota 55905, USA; Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, Minnesota 55905, USA. Electronic address: wolanskyj.alexandra@mayo.edu.

PMID: 35339260
DOI: 10.1016/j.hoc.2021.11.002

Abstract

Over the past decade, the role of immunotherapy treatment in cancer has expanded; specifically, indications for immune checkpoint inhibitors (ICI) have multiplied and are used as first-line therapy. ICIs include cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 inhibitors, as monotherapies or in combination. Autoimmune hemolytic anemia (AIHA) has emerged as a rare yet serious immune-related adverse event in ICI use. This review describes diagnosis and management of immunotherapy related AIHA (ir-AIHA) including an algorithmic approach based on severity of anemia. Suggested mechanisms are discussed, guidance on ICI resumption provided and prognosis reviewed including risk of recurrence.

Keywords: Autoimmune hemolytic anemia; Immune checkpoint inhibitors; Immune-related adverse event; Immunotherapy.

Publication types

Review

MeSH terms

Anemia, Hemolytic, Autoimmune* / chemically induced
Anemia, Hemolytic, Autoimmune* / diagnosis
Humans
Immune Checkpoint Inhibitors
Immunologic Factors / therapeutic use
Immunotherapy / adverse effects
Neoplasms* / drug therapy

Substances

Immune Checkpoint Inhibitors
Immunologic Factors