title: Delayed onset of autoimmune hemolytic anemia complicating cladribine therapy for Waldenström macroglobulinemia.
abstract: Therapeutic options for patients with Waldenström macroglobulinemia (WM) now include the purine nucleoside analogues, fludarabine and cladribine. Both these agents have been associated with the onset of severe life-threatening autoimmune hemolytic anemia (AIHA) in patients with chronic lymphocytic leukemia (CLL). In these reports, AIHA developed within 6 weeks of drug administration and was generally resistant to conventional therapy. AIHA following purine analogues has not been reported in other hematologic malignancies. We report here on 4 patients with WM who developed AIHA following cladribine therapy. Cladribine was administered as a 2-hour infusion at a dose of 0.12 mg/kg per day for 5 consecutive days, at 28-day intervals. The median number of cycles was four (range, 4 to 6). AIHA occurred at a median of 40 months (range, 24 to 60) from cladribine administration. Only 1 patient responded to oral steroids while the other 3 were resistant to multiple therapeutic interventions. Two patients, 1 in complete remission and 1 requiring transfusional support, remain alive, and 2 have died. In contrast to published reports of the early onset of AIHA occurring after purine analogues in CLL patients, we observed AIHA in WM patients as a delayed event.
authors.affiliation: Division of Hematology and Oncology, Ida M. and Cecil H. Green Cancer Center, Scripps Clinic, La Jolla, CA 92037, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Tetreault
authors.forename: A
authors.initials: A
authors.lastname: Saven
mesh_terms: D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced*; D017338:Cladribine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D017338:Cladribine