Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Cancer Chemother Pharmacol. 2013 Sep;72(3):709-13. doi: 10.1007/s00280-013-2243-5. Epub 2013 Aug 2.
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.
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.
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.
免疫性溶血性贫血（IHA）可使慢性淋巴细胞白血病（CLL）的病程复杂化，尤其是在晚期疾病患者中，也可作为苯丁酸氮芥或氟达拉滨治疗的并发症。苯达莫司汀是一种新型烷化剂和嘌呤类似物药物，于 2008 年在美国获批用于 CLL 的治疗。此后，关于其不良事件的临床数据不断积累。与苯达莫司汀相关的 IHA 很少见，因此对其进行了报告和综述。
我们评估了 31 例因疾病复发而接受苯达莫司汀治疗的 CLL 患者中 5 例并发 IHA 的病例。同时也回顾了文献中的既往病例报告。
苯达莫司汀相关性 IHA 比人们想象的更为常见（16%）。在非 CLL 患者中未发现此类病例。氟达拉滨诱发的自身免疫性溶血性贫血的个人病史可能是这种并发症的一个危险因素（5 例患者中有 4 例，80%）。其机制被认为与其他药物所描述的 T 细胞调节失控有关。使用苯达莫司汀治疗 CLL 的医生应注意这种并发症。
