title: Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: analysis of 533 adult patients who underwent transplantation at King's College Hospital.
abstract: Autoimmune hemolytic anemia (AIHA) is a recognized complication of hematopoietic stem cell transplantation (HSCT); it is often refractory to treatment and carries a high mortality. To improve understanding of the incidence, risk factors, and clinical outcome of post-transplantation AIHA, we analyzed 533 patients who received allogeneic HSCT, and we identified 19 cases of AIHA after HSCT (overall incidence, 3.6%). The median time to onset, from HSCT to AIHA, was 202 days. AIHA was associated with HSCT from unrelated donors (hazard ratio [HR], 5.28; 95% confidence interval [CI], 1.22 to 22.9; P = .026). In the majority (14 of 19; 74%) of AIHA patients, multiple agents for treatment were required, with only 9 of 19 (47%) patients achieving complete resolution of AIHA. Patients with post-transplantation AIHA had a higher overall mortality (HR, 2.48; 95% CI, 1.33 to 4.63; P = .004), with 36% (4 of 11 cases) of deaths attributable to AIHA.
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom. Electronic address: mengwang@nhs.net.
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.affiliation: School of Computing Sciences, University of East Anglia, Norwich, United Kingdom.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Abeywardane
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Malinthi
authors.initials: M
authors.lastname: Adikarama
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Donal
authors.initials: D
authors.lastname: McLornan
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Kavita
authors.initials: K
authors.lastname: Raj
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Hugues
authors.initials: H
authors.lastname: de Lavallade
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Devereux
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Ghulam J
authors.initials: GJ
authors.lastname: Mufti
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagliuca
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Victoria T
authors.initials: VT
authors.lastname: Potter
authors.affiliation: Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, and King's College London, London, United Kingdom.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Mijovic
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D035781:Siblings; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D006113:United Kingdom; D061349:Unrelated Donors
keywords: Allogeneic hematopoietic stem cell transplantation; Autoimmune hemolytic anemia; Mortality