Autoimmune hemolytic anemia: 2026 so far

Controlled trial evidence emerged for an IgG-lowering therapy.

In the months covered, the strongest new treatment evidence came from the ENERGY phase 2/3 trial (a mid-stage trial testing whether a treatment works and is safe) in warm AIHA. This was randomized and double-blind (people were assigned by chance, and neither patients nor clinicians knew which treatment was given). Nipocalimab met the primary endpoint only in the higher-dose group. Durable hemoglobin response was 23.7% (9/38) with 30 mg/kg every 4 weeks versus 7.7% (3/39) with placebo, while the 15 mg/kg schedule did not meet the endpoint. The higher-dose group had nominal (not definitive) fatigue improvement and greater average prednisone reduction over 24 weeks, with no new safety concerns reported beyond known risks. This gives trial-level evidence that lowering IgG (a type of antibody protein in the blood) can raise hemoglobin for some people with warm AIHA, and that the dose used may matter.

Research covered in: August 2026

Observational cohorts repeatedly linked combination therapy to better responses.

In the available routine-care (real-world) reports, steroids were still the most common starting treatment. Two observational cohorts linked steroids plus rituximab with better reported outcomes than steroids alone. A 125-person retrospective hospital study (a look back at medical records) reported higher response and more sustained remission with glucocorticoids plus rituximab than with steroids alone. A transplant-focused study of post-allogeneic stem cell transplant AIHA also linked corticosteroids plus rituximab with improved response, without major safety concerns reported in that dataset. Separately, a real-world rituximab cohort across autoimmune blood disorders reported infections (65/285) and infection-related deaths (9), showing that infection risk is part of the real-world context when rituximab is used. Taken together, these observational reports link steroids plus rituximab with better reported responses than steroids alone, while infection risk remains important in treatment decisions and follow-up, while also keeping infection risk in view during treatment decisions and follow-up.

Research covered in: April 2026, May 2026

More non-steroid approaches appeared, mostly outside randomized comparisons.

So far in 2026, several nonstandard or steroid-sparing approaches were reported for relapsed/refractory warm AIHA or Evans syndrome (a condition with two or more immune blood-cell problems). The strength of evidence ranged from a single-arm trial (everyone gets the same treatment) to small cohorts and case reports. A prospective, open-label, single-arm study of 78 adults with relapsed/refractory warm AIHA or Evans syndrome reported responses in about 4 out of 5 patients by 6 months, with relapse in 12.7% and side effects in 28.2% described as mostly mild and reversible. A 22-person retrospective cohort of refractory autoimmune cytopenias (immune-related low blood counts) reported quick responses with daratumumab + rituximab + glucocorticoids, including an 80.0% overall response rate and 60.0% complete response rate in the AIHA subgroup, with infections and rash reported and resolving. Early cell-therapy signals also appeared: one report of CD19 CAR T (a personalized immune-cell treatment) in 11 multi-refractory AIHA patients described complete remission in all participants with immune reactions and infections requiring monitoring, and additional single-patient CAR T reports were described in severe/refractory Evans syndrome/AIHA. These reports show what is being tried when standard therapies do not work, but most of these options still do not have randomized comparisons and the follow-up is limited.

Research covered in: January 2026, April 2026, June 2026, July 2026

More reports focused on matching blood and short-term stabilization.

In January to September reports, transfusion planning and acute stabilization often depended on specialized blood bank testing. This was because AIHA could overlap with alloantibodies (antibodies against transfused blood), drug-dependent antibodies (antibodies that react only with certain medicines present), or mixed warm/cold patterns. A single-hospital retrospective comparison suggested that using an added hemolysis lab test (a test looking for red blood cell breakdown) to guide donor blood selection improved short-term post-transfusion hemoglobin and hemolysis markers versus standard matching, but the summary did not report transfusion reactions or other safety outcomes. Case-based reports described rescue or bridge measures in extreme hemolysis, including therapeutic plasma exchange (filtering plasma to remove harmful antibodies) as a temporary bridge in lymphoma-associated severe warm AIHA, and whole-blood exchange/lymphoplasmapheresis-based approaches reported in ceftriaxone-induced immune hemolysis (with later commentary emphasizing unanswered questions about safety and reproducibility). In practice, this means transfusions and emergency stabilization may take extra time and extra testing, and the most dramatic rescue procedures still have limited evidence behind them.

Research covered in: February 2026, March 2026, June 2026, July 2026, September 2026

Reports sharpened when risks rise and how courses differ.

In the months covered, complications were often connected to how active the disease was and to a person's overall clinical situation. Several reports emphasized clot risk, infection risk, and the fact that relapse patterns can differ from person to person. A 92-person retrospective adult AIHA study reported that most later venous clots occurred during relapses rather than remission, and antiphospholipid antibodies (antibodies linked to clot risk) were present in 10/92; A kidney-transplant cohort involving autoimmune cytopenias and individual case reports, including an infant with AIHA after liver transplant, also described clotting complications in specific high-risk settings. Infection risk appeared in multiple contexts, including infections reported after CAR T in a small AIHA series and infections reported in a real-world rituximab cohort (65/285 infections; 9 infection-related deaths). Relapse heterogeneity was highlighted by pediatric cohorts where relapse was more common with Evans syndrome or underlying immune disorders, and by a case report suggesting relapse mechanisms can shift toward complement-dominant hemolysis (red blood cell breakdown driven more by the complement immune system) over time. Overall, these reports suggest that relapse periods and certain co-existing conditions can line up with more complications, which can influence how closely someone is monitored in routine care.

Research covered in: January 2026, April 2026, May 2026, July 2026, August 2026, September 2026