Clinical features, treatment and outcomes of adult warm autoimmune hemolytic anemia: A multicenter retrospective cohort study
Wenru Yue, Jie Shao, Yihan Liu, Meng Shu, Sijia Dong, Xiaoqin Wang, Ting WuBackground
Warm autoimmune hemolytic anemia (wAIHA) is a rare autoimmune disease characterized by hemolysis and anemia due to autoantibodies against erythrocytes, and few studies describe its clinical characteristics in China.
Objectives
To describe the clinical features of adult patients with wAIHA, and assess treatment patterns, response and overall survival.
Design
We performed a multicenter retrospective analysis of adult patients hospitalized with wAIHA between 01 January 2014 and 31 March 2024 in three hospitals in Shanghai, China.
Methods
The clinical, therapeutic and survival data of patients with wAIHA were analyzed. Overall survival (OS) was estimated using the Kaplan-Meier method, and Cox regression analysis was used to identify independent prognostic factors.
Results
A total of 202 patients were included, 51.5% with primary and 48.5% with secondary wAIHA. The median ages at diagnosis were 59.0 and 56.0 years, respectively. Of the primary patients 94.2% received corticosteroids as first-line therapy and 94.6% of them achieved a complete or partial response. Among 56 responders with available relapse information, 53.6% experienced at least one relapse. There were 64 patients who need further treatment while only 29.7% received second-line therapy. The median duration of corticosteroids use was 20.0 months and the most frequent corticosteroid-related complications were infections and diabetes. The survival rate at 1-year after diagnosis were 91.1% and 80.5% respectively in patients with primary and secondary wAIHA. Age ≥ 60 years, the presence of ≥ 2 comorbidities and infectious complications were associated with overall survival (
Conclusion
In our study, wAIHA is characterized by a relapsing clinical course and under-utilization of second-line treatment, highlighting significant unmet medical needs in the management of patients with wAIHA, and suggesting a need for improved clinical awareness.