Clinical features of multiple myeloma complicated with autoimmune hemolytic anemia: series of 11 cases

Objective To investigate the clinical features of multiple myeloma (MM) combined with autoimmune hemolytic anemia(AIHA), so as to raise the awareness of this disease. Methods We retrospectively analyzed 11 cases of multiple myeloma with autoimmune hemolytic anemia admitted to our hospital from 2013 to 2018, including their clinical features, laboratory findings, treatment and outcomes. Results Of the 11 patients with multiple myeloma, there were 4 males and 7 females with median age of 61 (41-77) years old, all patients presented with different clinical symptomsincluding bone pain, dizziness and fatigue. Autoimmune hemolytic anemia occurred during the initial diagnosis of multiple myeloma in 5 cases, and it occurred during the chemotherapy of multiple myeloma in 6 cases. Ten cases had different degrees of infection, mainly presented with pulmonary infection. The positive rate of Coombs test was 100% in 11 cases, and all of them were warm type. Among the 11 cases, 9 cases were IgG type and 2 were IgA type. Of the 11 cases in intermediate or late stage, 10 cases received chemotherapy regimens, among which 9 took thalidomide.Nine cases died, 1 case lost to follow-up and 1 case survived. The median survival was 7 (1-28) months, and the conversion rate of Coombs test was 27.2% (3/11) at the end of the follow-up. Conclusion Multiple myeloma combined with autoimmune hemolytic anemia is rare in clinical practice. Due to severe infection and hemolysis, the overall prognosis is poor and the mortality rate is high.