Objective  To explore the clinical characteristics and laboratory data of aggressive non-Hodgkin's lymphoma (NHL) complicated by autoimmune hemolytic anemia (AIHA).

  Methods  Data of six patients with aggressive NHL complicated by AIHA treated at the Second Affiliated Hospital of Suzhou University between September 2013 and July 2016 were reviewed retrospectively. The onset symptoms, disease progression, therapy, and prognostic factors were analyzed.

  Results  From September 2013 to July 2016, 155 patients with aggressive NHL were treated in our hospital. Six of them were complicated by AIHA (3.9%), with three males and three females, aged from 62 to 74. The median age was 67 years. The first clinical symptoms included the following:five presented with lymphadenectasis, three had fever, and one presented with multiple bone destruction and bone pain, all complicated by progressive hemoglobin decrease. Histological examination of the six patients revealed three cases with diffuse large B-cell lymphoma (DLBCL), including one case with positive Bcl-2, Bcl-6, and C-myc, and one case with positive CD5; one case was peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS); and two cases with angioimmunoblastic T-cell lymphoma (AITCL). Epstein-Barr virus (EBV)-mRNA (EBER) was detected by chromogenic in situ hybridization (CISH). Up to 100% (5/5) cases were EBER-positive. Eastern Cooperative Oncology Group scores of the six patients were three to four. All six cases were in the Ann-Arbor stagesⅢ-Ⅳ and International Prognostic Index score 4-5. All cases belonged to the high risk group. At the time when lymphoma was confirmed by pathology, the median level of hemoglobin was 56 (34-79) g/L. The median ratio of reticulocytes was 6.7(0.2-21.0) %. The positive rate of Coombs test was 100%. All cas-es showed autoantibodies against C3 (1:64-1:2 048). Four cases showed antoantibodies against G antigen (±~1:16). The plasma concentration of EBV DNA of three patients was detected and all increased. Except that 1 case gave up treatment, five patients received the chemotherapy with CHOP or R-CHOP. Four patients received prednisone between chemotherapy intermittent period. Two cases showed sustained complete response (CR). The overall survival (OS) was 20 and 14 months. Another patient with DLBCL and one patient with PTCL-NOS died from secondary severe pulmonary infection and heart failure during the myelosuppression. The OS times were 1.5 and 2 months, respectively. One patient with AITCL died in the disease progression after four cycles of chemotherapy. The OS was 4.5 months.

  Conclusion  Aggressive NHL complicated by AIHA is common in older patients with poor prognosis. The incidence rate of EBV infection was high, and hemolysis is rapid and serious. The patients' tolerance to chemotherapy was poor. Early diagnosis and effective chemotherapy may improve patients' prognosis.