Case Study: Autoimmune Hemolytic Anemia in Male Patient With CLL
Posted: Tuesday, August 10, 2021
An article published in Leukemia and Lymphoma described a rare case of autoimmune anemia related to venetoclax treatment in a patient with relapsed chronic lymphocytic lymphoma (CLL). Autoimmune disorders are a hallmark of CLL, and autoimmune hemolytic anemia may complicate the course of disease for these patients. Eirini Katodritou, MD, of Theagenio Cancer Hospital, Thessaloniki, Greece, and colleagues found that the patient’s initial response to venetoclax resulted in major improvements in all blood values; however, there was sudden anemia after dose escalation in the drug therapy.
This study reports the medical history and clinical outcomes of a 73-year-old male patient diagnosed with CLL (Binet stage A). AT 7 years post diagnosis, the patient presented with leukocytosis and a high absolute lymphocyte count; he was treated with cyclophosphamide/fludarabine, with no response. He then received ibrutinib, which induced a response but was discontinued due to development of a grade III skin rash. One year later, the disease progressed, resulting in excessive lymphocytosis, thrombocytopenia, and anemia, so venetoclax monotherapy was initiated. Venetoclax was administered orally (20 mg) and escalated weekly.
Following venetoclax treatment, there were initial improvements in all blood values examined, particularly a decrease in lymphocytes (absolute lymphocytic count = 83.600/UL), and anemia was corrected (hemoglobin = 9 g/dL). Upon dose escalation to 100 mg, the patient displayed sudden anemia (hemoglobin = 7.3 g/dL). Following further investigation of his anemic state, hemolysis was revealed, and a number of other markers confirmed autoimmune hemolytic anemia. Venetoclax was then suspended, and the patient was treated with corticosteroids; after another cycle of venetoclax (200 mg) and corticosteroids, hematologic values gradually returned to normal.
Based on these findings, Dr. Katodritou and colleagues concluded there is a need for close surveillance of patients receiving venetoclax and other novel agents. Additionally, adopting this strategy in routine clinical practice may help to better understand how autoimmune hemolytic anemia may be triggered.
Disclosure: The study authors reported no conflicts of interest.