title: Short communication: bendamustine-related hemolytic anemia in chronic lymphocytic leukemia.
abstract: OBJECTIVE
  Immune hemolytic anemia (IHA) may complicate the course of chronic lymphocytic leukemia (CLL), especially in patients with advanced disease, and as a complication of treatment with chlorambucil or fludarabine. Bendamustine, a novel agent with both alkylating and purine-analog properties, was approved in the USA for use in CLL in 2008. Since then, clinical data on its adverse events are accumulating. IHA related to bendamustine was seldom described and is thus reported and reviewed.
  
  
  METHODS
  We assessed five cases of CLL patients complicated by IHA, out of 31 treated with bendamustine for a relapse of their disease. Also reviewed are previous case reports in the literature.
  
  
  CONCLUSIONS
  Bendamustine-related IHA is more common than suspected (16 %). No such cases were found in non-CLL patients. Personal history of fludarabine-triggered AIHA may be a risk factor for this complication (recorded in 4/5 patients, 80 %). The mechanism is thought to be related to the loss of T cell regulatory control as described for other agents. Physicians using bendamustine for the treatment for CLL should be aware of this complication.
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Neta
authors.initials: N
authors.lastname: Goldschmidt
authors.forename: Alexander
authors.initials: A
authors.lastname: Gural
authors.forename: Dina
authors.initials: D
authors.lastname: Ben-Yehuda
authors.forename: Moshe E
authors.initials: ME
authors.lastname: Gatt
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000276:immunology; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use; D000069461:Bendamustine Hydrochloride; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009588:Nitrogen Mustard Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D013601:T-Lymphocytes / Q000378:metabolism
chemical_list: D018906:Antineoplastic Agents, Alkylating; D009588:Nitrogen Mustard Compounds; D000069461:Bendamustine Hydrochloride