Brief Answer: Please refer below Detailed Answer: Hi Thanks for your query. My answers to your queries.... 1. I want to know if there are cases of drug-induced hemolytic anemia and could tamoxifen make this worse? Are there alternatives to tamoxifen that would also allow me to take an anti-depressant? A. Drug-induced hemolytic anemia is well-known but there is no suggestion that tamoxifen can cause or worsen it. Even with tamoxifen you can take certain antidepressants like venlafaxine. Alternative to tamoxifen (considering you are premenopausal) is ovarian ablation, either by surgery or monthly injections of GnRH analogs. With these you can take other antidepressants also. 2. What is the relationship between taking ritoxin (ritoxib?) for the autoimmune hemoloytic anemia (as suggested by doctor) and my immune system? A. Rituxan (rituximab) is an antibody against B cells of the body so it helps to reduce the autoimmune response and improve the autoimmune hemolytic anemia. But it also damps the normal immunity of the body (like steroids) and increase susceptibility to some infections. 3. Will the damage to my overall immune system make it that much harder to fight a recurrence of cancer(s) in the future? A. No, I don't think there is any evidence to suggest that at this point. 4. which chemo may have caused that, and which other chemo drugs might have a better result? A. I don't think the chemo itself caused it. What had possibly happened is that chemo had reduced the bone marrow production of red cells. As you already had excess destruction of red cells, this weakening of bone marrow tipped the balance towards fall of hemoglobin level. Any other chemo can also cause that. 5. Does that imply that the chances are much greater for a metastasis, either in the other breast or in a distant part of my body? A. No, I don't think chemo would have had a great impact in preventing recurrences as the overall risk was quite low in your case. 6. In other words, is there a chance that I will have to try chemo again in the future, and if so, which drugs would be less likely to cause a hemolytic crisis, like happened with the taxotere/Cytoxan? A. Hopefully you would not have to take chemo in the future. If at all it is required, then we need to take a call at that time. Hope I have answered your query. I will be available to answer further followup queries, if any.

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