AUTOIMMUNE HEMOLYSIS IN PATIENTS WITH B-CLL TREATED WITH CHLORODEOXYADENOSINE (CDA)

We have treated 19 B-chronic Lymphocytic leukaemia (B-CLL) patients wi th CDA (Leustat, Janssen-Cilag). Four patients developed severe autoim mune haemolytic anaemia, and 2 of these had severe reticulocytopenia d ue to red cell aplasia/hypoplasia. Two patients died as a complication of the haemolysis one during the primary episode, with a clinical cou rse suggestive of transfusion associated graft-versus-host disease (ta GVHD), and one following a relapse of haemolysis. The onset of haemoly sis occurs within,4 cycles of CDA therapy and is temporally related to the T-lymphocyte nadir induced by CDA. The presence of a positive DAT prior to therapy in 3 of 4 patients developing haemolysis suggests th at the CDA induced T-lymphocytopenia may exacerbate the tendency of ce rtain CLL patients to autoimmune haemolysis.