Autoimmune hemolytic anemia risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Shyam Patel [2], Irfan Dotani
Overview
The risk factors for autoimmune hemolytic anemia include systemic lupus erythematosus and immunotherapeutic medications. Systemic lupus erythematosus is thought to be a strong risk factor for autoimmune hemolytic anemia. However, immunotherapeutic medications may become a more prevalent risk factor in the coming years as these agents are becoming used increasingly for a variety of cancers. These medications include anti-PD-1 antibodies and anti-CTLA-4 antibodies.
Risk Factors
In the majority of cases of autoimmune hemolytic anemia, the etiology is not found, and patients have no predisposing risk factors. However, there are certain conditions that can predispose a person to develop autoimmune hemolytic anemia. These conditions have an immunologic or autoimmune basis, with aberrant immune activation that results in the generation of autoantibodies against oneself.
- Systemic lupus erythematosus:
- The best autoimmune-related known risk factor is systemic lupus erythematosus.[1]
- SLE is a multisystem rheumatologic disease that is characterized by production of anti-double stranded DNA and anti-nuclear antibodies, with resultant autoimmune-mediated damage to a variety of organs including the kidneys, brain, skin, and peripheral blood.[1]
- Immunotherapy:
- Another risk factor for autoimmune hemolytic anemia is the use of immunotherapeutic agents to treat underlying cancer.
- Treatment of immunotherapy-related autoimmune hemolytic anemia involves corticosteroids and rituximab.[2]
- Pembrolizumab[3]: This is a humanized monoclonal antibody against PD-1. It is FDA-approved for metastatic or unresectable melanoma. It is approved for metastatic non-small cell lung cancer. It is approved for metastatic head and neck squamous cell carcinoma. It is approved for Hodgkin lymphoma in patients who experienced progression after 3 or more lines of therapy. It is indicated for metastatic urothelial cancer who are ineligible for platinum-based therapy. It is indicated for patients with metastatic gastric or gastroesophageal cancer expressing PD-L1. It is indicated for microsatellite instability-high (MSI-H) tumors after progression on chemotherapy.
- Nivolumab[4]: This is a monoclonal antibody against PD-1. This medication is FDA-approved for metastatic melanoma or for adjuvant treatment of melanoma involving regional lymph nodes. It is also approved for metastatic non-small cell lung cancer after progression on platinum-based chemotherapy. It is approved for renal cell carcinoma in patients who have received prior anti-angiogenic therapy. It is approved for patients with Hodgkin disease who have relapsed after autologous stem cell transplant and post-transplant brentuximab. It is approved for recurrent or metastatic head and neck squamous cell carcinoma after relapse with platinum-based chemotherapy. It is approved for metastatic urothelial cancer after progression on platinum-based chemotherapy. It is indicated for microsatellite instability-high (MSI-H) metastatic colon cancer after progression on standard chemotherapy. It is approved for hepatocellular carcinoma after treatment on sorafenib.
- Ipilimumab[5]: This is a humanized monoclonal IgG1 antibody against CTLA-4, which is an inhibitory receptor on T lymphocytes. It is FDA-approved for metastatic or unresectable malignant melanoma or for adjuvant treatment for non-metastatic melanoma that involves regional lymph nodes greater than 1mm.
- Atezolizumab: This is a humanized monoclonal antibody against PD-L1 on tumor cells. This medication is FDA-approved for patients with advanced or metastatic urothelial cancer who are ineligible for cisplatin-based therapy or have disease progression within 12 months of neoadjuvant or adjuvant chemotherapy. It is also approved for patients with metastatic non-small cell lung cancer who have had disease progression on platinum-based chemotherapy.
- Avelumab: This is a humanized monoclonal IgG1 antibody against PD-L1 on tumor cells. This medication is FDA-approved for patients above the age of 12 with metastatic Merkel cell carcinoma.
References
- ↑ 1.0 1.1 Fujii J, Kurahashi T, Konno T, Homma T, Iuchi Y (2015). "Oxidative stress as a potential causal factor for autoimmune hemolytic anemia and systemic lupus erythematosus". World J Nephrol. 4 (2): 213–22. doi:10.5527/wjn.v4.i2.213. PMC 4419130. PMID 25949934.
- ↑ Khan U, Ali F, Khurram MS, Zaka A, Hadid T (2017). "Immunotherapy-associated autoimmune hemolytic anemia". J Immunother Cancer. 5: 15. doi:10.1186/s40425-017-0214-9. PMC 5319184. PMID 28239468.
- ↑ Atwal D, Joshi KP, Ravilla R, Mahmoud F (2017). "Pembrolizumab-Induced Pancytopenia: A Case Report". Perm J. 21. doi:10.7812/TPP/17-004. PMC 5528855. PMID 28746020.
- ↑ Palla AR, Kennedy D, Mosharraf H, Doll D (2016). "Autoimmune Hemolytic Anemia as a Complication of Nivolumab Therapy". Case Rep Oncol. 9 (3): 691–697. doi:10.1159/000452296. PMC 5126613. PMID 27920704.
- ↑ Quirk SK, Shure AK, Agrawal DK (2015). "Immune-mediated adverse events of anticytotoxic T lymphocyte-associated antigen 4 antibody therapy in metastatic melanoma". Transl Res. 166 (5): 412–24. doi:10.1016/j.trsl.2015.06.005. PMC 4609598. PMID 26118951.