Autoimmune haemolysis in patients with B-CLL treated with chlorodeoxyadenosine (CDA).
We have treated 19 B-chronic lymphocytic leukaemia (B-CLL) patients with CDA (Leustat, Janssen-Cilag). Four patients developed severe autoimmune haemolytic anaemia, and 2 of these had severe reticulocytopenia due to red cell aplasia/hypoplasia. Two patients died as a complication of the haemolysis one during the primary episode, with a clinical course suggestive of transfusion associated graft-versus-host disease (taGVHD), and one following a relapse of haemolysis. The onset of haemolysis 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 that the CDA induced T-lymphocytopenia may exacerbate the tendency of certain CLL patients to autoimmune haemolysis.
Department of Haematology, Derriford Hospital, Plymouth, UK.
R C
RC
Chasty
H
H
Myint
D G
DG
Oscier
J A
JA
Orchard
D P
DP
Bussutil
M D
MD
Hamon
A G
AG
Prentice
J A
JA
Copplestone
D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000139:chemically induced*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D017338:Cladribine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015448:Leukemia, B-Cell / Q000097:blood / Q000188:drug therapy*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced
D000970:Antineoplastic Agents; D017338:Cladribine