Autoimmune hemolytic anemia in patients with non-Hodgkin's lymphoma: Characteristics and significance

Background: The occurrence of autoimmune hemolytic anemia (AIHA) in patient s with non-Hodgkin's lymphoma (NHL) is well known. However, there is lack o f information in the literature in terms of the significance and impact of such phenomenon on the clinical course of these patients. Patients and methods: We analyzed the clinical and laboratory features, cou rse and response of 16 patients with non-Hodgkin's lymphoma (NHL) and autoi mmune hemolytic anemia (AIHA). Patients with small lymphocytic lymphoma and angioimmunoblastic lymphadenopathy with dysproteinemia were excluded from the analysis. The significance of certain parameters, such as cell type (B- vs. T-cell), stage of NHL and presence of serum monoclonal immunoglobulin were examined. The cohort consisted of 501 patients with NHL evaluated during the study p eriod. Results: The response rate for the group of patients with NHL/AIHA and for the cohort was 44% and 62%, respectively; P = 0.0138. T-cell histology was overrepresented in the patients with AIHA/NHL (33% vs. 14%; P = 0.048). The occurrence of AIHA was not statistically significant among the four stages of NHL (P = 0.722), while a significantly higher proportion of patients wi th AIHA had serum monoclonol gammopathy when compared to the cohort (25% vs . 8%; P = 0.03). The patients with NHL who did not develop AIHA had better overall survival and median survival compared to the NHL/AIHA group (P = 0. 006 and P = 0.0001, respectively). Conclusions: The study provides for the first time a descriptive clinicopat hologic analysis of patients with AIHA and NHL. Certain pathologic and labo ratory features were more likely to be associated with the occurrence of AI HA in patients with NHL. Most importantly, was the adverse impact of AIHA o n the survival of patients with NHL. Therefore, this finding should be take n in consideration when risk-stratifying patients with NHL.