Journal
PATHOLOGY
Volume 53, Issue 5, Pages 608-612Publisher
ELSEVIER
DOI: 10.1016/j.pathol.2020.10.023
Keywords
Alectinib; spherocytosis; acanthocytosis; eosin-5-maleimide
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The study found that most patients treated with alectinib experienced red blood cell membrane abnormalities, with almost all patients developing anemia, though definite new hemolysis was present in only a few patients.
We reviewed haematological investigations for 43 patients treated at a single centre with alectinib, an inhibitor of anaplastic lymphoma kinase (ALK) which is considered standard first-line treatment for patients with ALKrearranged advanced non-small cell lung cancer. Ninetyfive percent of patients developed marked acanthocytosis, echinocytosis and/or spheroacanthocytosis, not observable with prior treatment with other ALK-inhibitors. Anaemia developed in 73% of patients (38% <100 g/L, 8% <80 g/L), though definite new haemolysis was present in only 11%. Eosin-5-maleimide binding was reduced in all assessed patients, and increased membrane cholesterol was identified in one patient assessed with lattice light sheet microscopy. We have identified a previously undescribed phenomenon whereby alectinib induces red cell membrane abnormalities in nearly all patients through an unclear, but likely ALK-independent, mechanism, resulting in mild anaemia without universal haemolysis.
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