A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis

Abstract Alectinib is an orally bioavailable anaplastic lymphoma kinase (ALK) inhibitor indicated for ALK mutated non-small cell lung cancer (NSCLC). This case series documents the development of significant erythrocyte membrane changes associated with alectinib use in six patients. Morphological findings found on blood film examination include moderate-marked acanthocytes, spheroacanthocytes, and one demonstrated moderate schistocytes. Two patients this multi-centre developed grade 1 anaemia, four 2 anaemia. suffered non-immune-related haemolysis. One patient had a co-existing β thalassaemia trait required treatment cessation due to severe Low-grade anaemia was seen 22% using ALEX trial 5% ≥ 3 Alterations morphology structure have not been reported safety data clinical trials date. Drug-induced acanthocytosis rare phenomenon has previously high-dose prostaglandin administration only. highlights important laboratory finding sequelae. Alectinib-associated likely be more prevalent than recognised. We also highlight need vigilance haematopathology departments unexpected novel therapies. These can detected post-marketing surveillance phase may serious implications