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Annals of Oncology 11:1571-1577, 2000
© 2000 European Society for Medical Oncology

research-article

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

S. Sallah1,, G. Sigounas2, P. Vos3, J. Y. Wan4 and N. P. Nguyen5

1Department of Medicine, Division of Hematologv/Oncologi University of Tennessee Memphis, Tennessee
2Division of Hematology/Oncology and Bone Marrow Transplantation Greenville, North Carolina
3Department of Preventive Medicine, East Carolina University Greenville, North Carolina
4Department of Biostatistics, University of Tennessee Memphis, Tennessee
5Department of Radiation Oncology, Southwestern University Dallas, Texas, USA

Correspondence to: S. Sallah, MD Assistant Professor of Medicine Department of Hematology/Oncology College of Medicine University of Tennessee, Memphis 3 North Dunlap Memphis, TN 38163 USA E-mail: ssallah{at}utmem.edu

Background: The occurrence of autoimmune hemolytic anemia (AIHA) in patients with non-Hodgkin's lymphoma (NHL) is well known. However, there is lack of 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, course and response of 16 patients with non-Hodgkin's lymphoma (NHL) and autoimmune 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 period.

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 with 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 clinicopathologic analysis of patients with AIHA and NHL. Certain pathologic and laboratory features were more likely to be associated with the occurrence of AIHA in patients with NHL. Most importantly, was the adverse impact of AIHA on the survival of patients with NHL. Therefore, this finding should be taken in consideration when risk-stratifying patients with NHL.

autoimmune hemolytic anemia, non-Hodgkin's lymphoma, treatment


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