Clinical characteristics, treatment patterns and long-term outcomes of warm and mixed autoimmune hemolytic anemia: insights from a real-world study
- 1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
- 2Tianjin Institutes of Health Science
Abstract
Objective: Autoimmune hemolytic anemia (AIHA) represents a heterogeneous group of autoimmune disorders, with limited large-scale real-world evidence from Asian populations. This study aimed to characterize the clinical characteristics, treatment patterns, and long-term outcomes of patients with warm AIHA (wAIHA) and mixed AIHA (mAIHA).
Methods: This single-center retrospective study screened 629 patients with AIHA hospitalized in China between 2014 and 2023. After excluding 32 patients with cold AIHA and 31 with DAT-negative AIHA, 566 patients (449 wAIHA and 117 mAIHA) were included, with a median follow-up of 57 months.
Results: Compared with wAIHA, mAIHA patients presented with earlier onset, poorer bone marrow compensation, and cold AIHA-like features despite comparable hemoglobin levels. Secondary AIHA was more prevalent in mAIHA (39.3% vs. 22.5%). Glucocorticoids remained the first-line treatment with similar response rates in both subtypes, while rituximab was the predominant second-line therapy. Treatment strategies and outcomes with multiple emerging therapies were also summarized. Median event-free survival was 17 months, with relapses mainly occurring during treatment tapering or infections. Estimated overall survival (OS) rates at 1, 3, and 5 years were 96%, 92%, and 89%, respectively, with infections and disease progression being leading causes of mortality. Independent risk factors associated with OS included age ≥60, hemoglobin at onset <6 g/dL, bone marrow responsiveness index <121, male sex, and an IgM+IgA-mediated serological pattern, whereas cold agglutinin titers demonstrated limited value in predicting OS or treatment response.
Conclusions: mAIHA and wAIHA share comparable glucocorticoid response and long-term survival despite distinct clinical and serological characteristics. This large real-world cohort delineates the profiles of wAIHA and mAIHA and identifies baseline factors associated with OS to support individualized management. Emerging therapies present promising prospects in AIHA management.
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BibTeX
@article{zhang2026clinical,
title = {{Clinical characteristics, treatment patterns and long-term outcomes of warm and mixed autoimmune hemolytic anemia: insights from a real-world study}},
author = {Junan Zhang and Yuan Li and Jiewen Qiu and Yizhou Zheng and Meili Ge and Fengkui Zhang and Jun Shi and Xin Zhao},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1931581},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1931581/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical characteristics, treatment patterns and long-term outcomes of warm and mixed autoimmune hemolytic anemia: insights from a real-world study
AU - Junan Zhang
AU - Yuan Li
AU - Jiewen Qiu
AU - Yizhou Zheng
AU - Meili Ge
AU - Fengkui Zhang
AU - Jun Shi
AU - Xin Zhao
PY - 2026
DA - 2026/10/12
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1931581
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1931581/full
AB - Objective: Autoimmune hemolytic anemia (AIHA) represents a heterogeneous group of autoimmune disorders, with limited large-scale real-world evidence from Asian populations. This study aimed to characterize the clinical characteristics, treatment patterns, and long-term outcomes of patients with warm AIHA (wAIHA) and mixed AIHA (mAIHA). Methods: This single-center retrospective study screened 629 patients with AIHA hospitalized in China between 2014 and 2023. After excluding 32 patients with cold AIHA and 31 with DAT-negative AIHA, 566 patients (449 wAIHA and 117 mAIHA) were included, with a median follow-up of 57 months. Results: Compared with wAIHA, mAIHA patients presented with earlier onset, poorer bone marrow compensation, and cold AIHA-like features despite comparable hemoglobin levels. Secondary AIHA was more prevalent in mAIHA (39.3% vs. 22.5%). Glucocorticoids remained the first-line treatment with similar response rates in both subtypes, while rituximab was the predominant second-line therapy. Treatment strategies and outcomes with multiple emerging therapies were also summarized. Median event-free survival was 17 months, with relapses mainly occurring during treatment tapering or infections. Estimated overall survival (OS) rates at 1, 3, and 5 years were 96%, 92%, and 89%, respectively, with infections and disease progression being leading causes of mortality. Independent risk factors associated with OS included age ≥60, hemoglobin at onset <6 g/dL, bone marrow responsiveness index <121, male sex, and an IgM+IgA-mediated serological pattern, whereas cold agglutinin titers demonstrated limited value in predicting OS or treatment response. Conclusions: mAIHA and wAIHA share comparable glucocorticoid response and long-term survival despite distinct clinical and serological characteristics. This large real-world cohort delineates the profiles of wAIHA and mAIHA and identifies baseline factors associated with OS to support individualized management. Emerging therapies present promising prospects in AIHA management.
SN - 1664-3224
ER -