Poor Prognosis for Lymphoma-associated AIHA, Case Report Shows

People with non-Hodgkin’s lymphoma (NHL) — a type of blood cancer — that co-occurs with autoimmune hemolytic anemia (AIHA) have a poor prognosis, suggesting a need for further research into this rare combination of conditions, a case report highlights.

The case was reported at the 2020 Lymphoma, Leukemia and Myeloma Congress, recently held virtually, in a presentation titled “Mixed Autoimmune Hemolytic Anemia: Rare Presentation of Diffuse Large B‐Cell Lymphoma” (abstract P-38).

AIHA occurs when the immune system makes antibodies that attack the body’s own red blood cells — the cells that carry oxygen through the blood using the oxygen-binding protein hemoglobin. When the antibodies are active at body temperature, the condition is referred to as warm AIHA; cold agglutinin disease (CAD) refers to AIHA caused by antibodies that are active at colder temperatures, usually between 32 to 50 F (0 and 10 C).

In about 5% of AIHA cases, there are antibodies that are active at both warm and cold temperatures, which is referred to as mixed AIHA.

The new report, from researchers at Danbury Hospital, in Connecticut, describes a 95-year-old man with a history of heart disease and kidney cancer, which was in remission. The patient was treated at the hospital after experiencing increasing light‐headedness and shortness of breath upon exertion.

Laboratory tests revealed abnormally low hemoglobin levels (anemia), and confirmed the presence of both warm and cold antibodies, leading to a diagnosis of mixed AIHA.

Eventually, the patient underwent a bone marrow biopsy, which led to a diagnosis of diffuse large B‐cell lymphoma.  That is the most common type of NHL, which is caused by B-cells (a type of immune cell) that grow uncontrollably, becoming cancerous.

Previous research had indicated that AIHA develops in about 1% of people with NHL.

“These cases responded poorly to chemotherapy and had less favorable outcome with standardized treatment,” the researchers wrote.

The man was treated with rituximab, a B-cell targeting therapy, along with chemotherapy and steroids. However, the patient developed a catheter-associated infection, which complicated treatment. Ultimately, the decision was made to maximize the patient’s comfort, and he died two months after being diagnosed.

“A small portion of NHLs are associated with AIHA,” the researchers concluded. “The prognosis of NHL with AIHA is poor and more study is necessary to better understand this rare condition.”