Abdel-Samad Nizar, Sughayar Rana
Department of Internal Medicine, The Moncton Hospital, Moncton, New Brunswick, Canada.
Oncology Clinical Trials, The Moncton Hospital, Moncton, New Brunswick, Canada.
Am J Case Rep. 2021 Mar 10;22:e928514. doi: 10.12659/AJCR.928514.
BACKGROUND Chronic lymphocytic leukemia (CLL) is a hematological disease characterized by the clonal proliferation and accumulation of neoplastic B lymphocytes in the blood, bone marrow, lymph nodes, and spleen. Autoimmune hemolytic anemia (AIHA) is an acquired hemolytic anemia in which the destruction of erythrocytes is helped by anti-erythrocyte auto-antibodies. This has a controversial effect on the clinical outcome and survival of patients with CLL. Venetoclax, a second-generation BH3 mimetic compound, is one of the new therapies that has been approved for the treatment of CLL. Venetoclax disrupts the antiapoptotic signaling through BCL2. Common adverse events associated with venetoclax include neutropenia, thrombocytopenia, and diarrhea. This case report describes a patient with CLL who developed AIHA when treated with venetoclax. CASE REPORT A patient of 62-year-old woman, who was treated with multiple lines of therapy, presented autoimmune hemolytic anemia after treatment with venetoclax. The anemia was resolved after holding venetoclax and being treated with rituximab. In January 2019, there were reports of 7 patients developing AIHA related to venetoclax therapy in Europe, according to the EudraVigilance database. How venetoclax can cause AIHA is not completely clear. This complication can happen when the erythrocyte antigen is altered by the drug that can produce antibodies. The other described mechanism is the binding of the drug with erythrocytes, which leads to production of an immune response. CONCLUSIONS Although AIHA can be a complication of CLL, it may be caused by treatment with venetoclax. That may be confirmed after eliminating other causes.
慢性淋巴细胞白血病（CLL）是一种血液系统疾病，其特征为肿瘤性B淋巴细胞在血液、骨髓、淋巴结和脾脏中克隆性增殖和积聚。自身免疫性溶血性贫血（AIHA）是一种获得性溶血性贫血，其中抗红细胞自身抗体促进红细胞破坏。这对CLL患者的临床结局和生存具有争议性影响。维奈克拉是一种第二代BH3模拟化合物，是已被批准用于治疗CLL的新疗法之一。维奈克拉通过BCL2破坏抗凋亡信号传导。与维奈克拉相关的常见不良事件包括中性粒细胞减少、血小板减少和腹泻。本病例报告描述了一名CLL患者在接受维奈克拉治疗时发生AIHA。
一名62岁女性患者，接受过多种治疗，在接受维奈克拉治疗后出现自身免疫性溶血性贫血。停用维奈克拉并接受利妥昔单抗治疗后贫血得到缓解。根据欧洲药物警戒数据库（EudraVigilance），2019年1月，欧洲有7例报告称患者在接受维奈克拉治疗时发生与AIHA相关的情况。维奈克拉如何导致AIHA尚不完全清楚。当药物改变红细胞抗原从而产生抗体时，可能会发生这种并发症。另一种描述的机制是药物与红细胞结合，从而引发免疫反应。
虽然AIHA可能是CLL的一种并发症，但也可能由维奈克拉治疗引起。在排除其他原因后可能得到证实。
