Abstract
Alectinib, an ALK inhibitor used for ALK+ non-small cell lung cancer and other malignancies, has been associated with anemia and RBC abnormalities, including acanthocytosis. We report the first case of alectinib-induced acanthocytosis and hemolysis causing anemia during treatment for anaplastic large cell lymphoma in an 11-year-old boy. Extensive testing, including next-generation sequencing, and a specific indirect antiglobulin test conducted with alectinib, was performed to document this hemolytic anemia. Dose reduction improved hemoglobin levels, allowing completion of the 2-year treatment, suggesting a dose-dependent mechanism. Blood counts and morphology normalized after discontinuation of alectinib. A comprehensive literature review and discussion of the underlying mechanisms are also provided.
Overview
- This study reports the first case of alectinib-induced acanthocytosis and hemolysis causing anemia in an 11-year-old boy with anaplastic large cell lymphoma.
- The patient underwent extensive testing, including next-generation sequencing, and a specific indirect antiglobulin test to document hemolytic anemia.
- The study aims to document this rare adverse effect and provide a comprehensive review of the underlying mechanisms and literature information.
Comparative Analysis & Findings
- Alectinib, an ALK inhibitor, is known to be associated with anemia and RBC abnormalities, including acanthocytosis.
- The study reports the first case of alectinib-induced acanthocytosis and hemolysis causing anemia in a pediatric patient.
- Dose reduction of alectinib improved hemoglobin levels, allowing completion of the 2-year treatment, suggesting a dose-dependent mechanism.
Implications and Future Directions
- This rare adverse effect of alectinib highlights the importance of closely monitoring patients receiving the medication for signs of hemolytic anemia.
- Future studies should investigate the underlying mechanisms of alectinib-induced acanthocytosis and hemolysis to better understand this adverse effect.
- Clinicians should consider alectinib-induced acanthocytosis and hemolysis in pediatric patients with lymphoma receiving alectinib, and consider dose reduction or other alternatives as needed.