Changes in Red Cell Morphology and Haematological Laboratory Parameters Associated With Alectinib

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Alectinib is a second-generation anaplastic lymphoma kinase (ALK) inhibitor for ALK-mutated non-small-cell lung cancer.
• Previous reports suggest a link between alectinib and red blood cell abnormalities.
• This study investigates these associations further.

Purpose of the Study:

• To determine the frequency of acanthocytosis in patients treated with alectinib.
• To evaluate changes in red blood cell indices and hemolysis markers.
• To assess eosin-5-maleimide (EMA) binding in patients on alectinib.

Main Methods:

• Retrospective observational study of patients receiving alectinib.
• Analysis of complete blood counts before and after alectinib initiation.
• Evaluation of biochemical markers of hemolysis and EMA binding assays.

Main Results:

• All fifty evaluated patients showed significant acanthocytosis (3+ on peripheral smears).
• Post-alectinib blood tests revealed lower hemoglobin, RBC count, and hematocrit.
• Increased mean corpuscular hemoglobin, MCHC, RDW, and reduced EMA binding were observed.

Conclusions:

• Alectinib treatment consistently causes significant acanthocytosis in patients.
• Alectinib is associated with hemolysis, spherocytic and anisopoikilocytic morphology.
• Reduced EMA binding in patients on alectinib suggests altered red blood cell membranes.