Venetoclax as a trigger for autoimmune hemolytic anemia in secondary acute myeloid leukemia: A case report

Venetoclax, a BCL-2 inhibitor used in chronic lymphocytic leukemia and acute myeloid leukemia, has been rarely associated with autoimmune hemolytic anemia, mostly in chronic lymphocytic leukemia. We report the first case of venetoclax-triggered autoimmune hemolytic anemia in acute myeloid leukemia secondary to chronic myelomonocytic leukemia. An 80-year-old man developed abrupt warm autoimmune hemolytic anemia 4 days after venetoclax initiation with azacitidine. Hemolysis resolved rapidly after venetoclax withdrawal and corticosteroid therapy. Rechallenge led to compensated hemolysis. This case supports venetoclax causality and highlights that autoimmune hemolytic anemia can occur beyond lymphoid malignancies. Clinicians should monitor for autoimmune cytopenias during venetoclax therapy, even in myeloid disorders.