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Clinical characteristics, treatment patterns and long-term outcomes of warm and mixed autoimmune hemolytic anemia: insights from a real-world study

Year: 2026

Type: article

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.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1931581