The Role of Novel Agents in Treating CLL-Associated Autoimmune Hemolytic Anemia (AIHA)

[Jm954]

J. Clin. Med. 2021, 10, 2064

There have apparently never been any prospective clinical trials conducted in the setting of CLL-associated AIHA, as patients with uncontrolled AICs are typically excluded from trials. This paper looks at the role of novel agents in treating AIHA and suggests that BTKi's are most suited because of their immune modulation effects.

When doctors are considering treatment, the acuteness of onset, the severity of anemia and the degree of hemolysis must be taken into account, together with patient’s symptoms, age and co-morbidities. Blood transfusions are usually indicated with Hb < 6 g/dL or higher in elderly comorbid patients but over-transfusion should be avoided since it carries a high risk of allo-immunization where the patient makes antibodies to the transfused blood. Isolated AIHA is not a criterion to treat CLL, patients in A stage should not receive CLL directed treatment.

In Conclusion

"Small molecule inhibitors are able to exert excellent disease control in CLL and this activity on disease burden is usually able to extinguish the autoimmune dysfunction that is responsible for AIHA and related immune cytopenias.

However, the choice of the right agent seems important as, with very little literature available so far, not all new drugs are able to yield the same efficacy in repressing hemolysis. Because of their ability to produce a deep change in the cytokine asset that is (at least partly) responsible for autoimmunity in CLL, to date BTK-inhibitors stand out as the most suitable choice.

In the near future, clinical studies employing BTK-inhibitors as treatments for CLL- related AICs will manage to cast new light on their potential role as an earlier therapy line

This is the abstract link but you can download the full PDF from this page: mdpi.com/2077-0383/10/10/2064

Jackie

[Jm954 Administrator]

**IMPORTANT**

If anyone has AIHA or a suspicion of it then the first thing to do is see your doctor!

Please DO NOT EVER attempt to heal yourself with diet or other alternative means, you could die within a few days if the haemolysis is very bad without treatment. This is not an exaggeration, I have seen patients drop their Hb by 7g/dl in just. few days and be in need of very urgent blood transfusions.

Your doctor will know what is the best treatment for your stage of CLL and situation.

Jackie

[tesoro5858]

I developed AIHA in March 2021, 2 weeks after COVID vaccine dose 1 (coincidence?). I have reported this to the CDC. My CLL is treatment naive, dx 2014, 13q del and mutated IGHV. No other known mutations. I was refractory to oral prednisone therapy. I received 2nd dose of COVID vaccine, waited 2 weeks, and had 6 cycles of obinutuzumab monotherapy which repressed the hemolysis and, as a positive side benefit, put my CLL in remission. There is very little data published about this treatment for AIHA so I will report if/when things change as my B cells recover from the CD20 antibody treatments.

Susan