COVID-19ワクチン接種に続発した自己免疫性溶血性貧血

抄録

A 72-year-old woman was diagnosed as having diffuse large B-cell lymphoma (DLBCL) in 2017 and showed complete remission (CR) in response to six courses of R-CHOP therapy. In April 2021, when she developed her first disease relapse, she was started on bendamustine-rituximab (BR) as salvage chemotherapy. In June 2021, 23 days after she received her second vaccination for coronavirus disease 2019 (COVID-19) with the BNT162b2 vaccine, she was hospitalized with severe anemia. Blood and bone marrow examinations revealed evidence suggestive of pure red cell aplasia with hemolytic anemia. The anemia resolved rapidly with the administration of prednisolone (PSL), and after two courses of BR, the patient achieved CR again. In March 2022, 29 days after a booster COVID-19 vaccination with the mRNA 1273 vaccine, the patient was re-hospitalized with Coombs-positive autoimmune hemolytic anemia (AIHA), and again showed rapid treatment response to PSL administration. Considering that our patient experienced repeated episodes of hemolytic anemia after COVID-19 vaccinations, we suspected an autoimmune mechanism secondary to COVID-19 vaccination as underlying the development of hemolytic anemia in our patient.