This protocol addresses patients with chronic lymphocytic leukaemia (CLL) who develop autoimmune cytopenias — specifically autoimmune haemolytic anaemia (AIHA) or immune thrombocytopenia (ITP). These complications arise in a meaningful subset of CLL patients and directly shape treatment decisions.
AIHA and, to a lesser extent, ITP occur in approximately 5%–7% of CLL patients. Initial management follows the same approach as primary AIHA or ITP; however, when autoimmune cytopenias respond poorly to these measures, the indication for CLL-directed treatment arises.
When autoimmune cytopenias are poorly responsive to corticosteroids and rituximab, CLL-directed targeted therapy is indicated — BTKi-based regimens are among the recommended approaches in this setting. The complete options, combinations, and sequencing are detailed in the full protocol.
Autoimmune haemolytic anaemia (AIHA) and, to a lesser extent, immune thrombocytopenia (ITP), are relatively frequent in CLL (5%–7%).
CLL patients with simple AIC should be managed in the same way as patients with primary AIHA or ITP (GRADE 1D).
AIC poorly responsive to corticosteroids and rituximab remain as an indication for CLL treatment.
Treatment with BTKi monotherapy, BTKi/BCL2i combinations or BCL2/anti-CD20 antibody combinations are recommended options (GRADE 2B).
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