Clinical Features, Treatment, and Outcomes of Nivolumab-induced Autoimmune Hemolytic Anemia

To investigate the clinical profile of nivolumab-induced autoimmune hemolytic anemia (AIHA) and to reveal the diagnostic and therapeutic patterns of this disease. Articles on nivolumab-induced AIHA published before October 31, 2025 were included. Clinical data were collected for retrospective analysis. A total of 29 patients were included, with a median age of 67 years (range: 18, 89). AIHA occurred at a median of 57 days (range: 6, 390) following initial nivolumab administration, with a median treatment cycle of 3 cycles (range: 1, 39). Fatigue (76.9%) and dyspnea (53.8%) were the predominant clinical manifestations. The laboratory analysis indicated that the median concentrations of hemoglobin and lactate dehydrogenase were 6.2 g/dL (range: 3.5, 8.7) and 710.5 U/L (range: 200, 1574), respectively. Direct antiglobulin test (DAT) results were seronegative in 10.3% and seropositive in 89.7%. Following nivolumab discontinuation and administration of systemic steroids, immunosuppressants, and transfusion support, 89.7% of patients achieved remission. AIHA is a rare and fatal event of nivolumab. DAT may yield negative results in some cases. Warm AIHA is the most common type of nivolumab-induced AIHA. Systemic steroids are the first-line option for AIHA. Refractory AIHA and cAIHA require additional immunosuppressive therapy.