Autoimmune Hemolytic Anemia after Allogeneic Hematopoietic Stem Cell Transplantation: Analysis of 533 Adult Patients Who Underwent Transplantation at King's College Hospital

• Clinically significant autoimmune hemolytic anemia occurs in 3.6% patients after allogeneic hematopoietic stem cell transplantation, at a median of 202 days.
• Hematopoietic stem cell transplantation from unrelated donors was a significant risk factor for development of autoimmune hemolytic anemia.
• Patients developing autoimmune hemolytic anemia also exhibited increased frequency of alloimmunization to red cell antigens.
• Seventy-four percent of patients required second-line therapy or more for the treatment of autoimmune hemolytic anemia.
• Patients had higher mortality after onset of autoimmune hemolytic anemia.

Autoimmune hemolytic anemia (AIHA) is a recognized complication of hematopoietic stem cell transplantation (HSCT); it is often refractory to treatment and carries a high mortality. To improve understanding of the incidence, risk factors, and clinical outcome of post-transplantation AIHA, we analyzed 533 patients who received allogeneic HSCT, and we identified 19 cases of AIHA after HSCT (overall incidence, 3.6%). The median time to onset, from HSCT to AIHA, was 202 days. AIHA was associated with HSCT from unrelated donors (hazard ratio [HR], 5.28; 95% confidence interval [CI], 1.22 to 22.9; P = .026). In the majority (14 of 19; 74%) of AIHA patients, multiple agents for treatment were required, with only 9 of 19 (47%) patients achieving complete resolution of AIHA. Patients with post-transplantation AIHA had a higher overall mortality (HR, 2.48; 95% CI, 1.33 to 4.63; P = .004), with 36% (4 of 11 cases) of deaths attributable to AIHA.