1. Case Report: Successful Treatment of Steroid-Refractory Immune Checkpoint Inhibitor-Related Pure Red Cell Aplasia With Cyclosporin
- Author
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Audrey Fresse, Annick Boscagli, Fanny Rocher, Elise Van-Obberghen, Milou-Daniel Drici, Marine Muzzone, Nadège Parassol, Alexandre Gérard, Delphine Borchiellini, and Serena Romani
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,steroid-refractory ,Anemia ,medicine.medical_treatment ,Pure red cell aplasia ,immune checkpoint inhibitor ,Gastroenterology ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Internal medicine ,medicine ,case report ,nivolumab ,business.industry ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,anemia ,Discontinuation ,cyclosporin ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,pure red cell aplasia ,030220 oncology & carcinogenesis ,Bone marrow ,Nivolumab ,Packed red blood cells ,business ,Adjuvant - Abstract
Anemia associated with Immune checkpoint inhibitor (ICI) is usually hemolytic and regenerative. Cases of non-regenerative pure red cell aplasia are rare, and typically improve upon drug discontinuation and after corticotherapy. We herein report a case of nivolumab-related erythroblastopenia refractory to steroids in a melanoma patient that improved only after treatment with cyclosporin. Nivolumab had been well tolerated for 2 months after being introduced as an adjuvant treatment. Hemoglobin level then progressively decreased from 12.7 g/dl as baseline value to a nadir of 4.3 g/dL despite transfusion with a total of 29 packed red blood cells in 3 months. Extensive workup including repeated bone marrow examinations led to the diagnosis of pure red cell aplasia. Anemia persisted despite nivolumab discontinuation and over a month of corticotherapy, but improved dramatically 3 days after cyclosporin initiation and did not recur upon cyclosporin tapering. The patient remains cancer-free 9 months after nivolumab withdrawal. This case highlights the under-recognized risk of erythroblastopenia in patients treated with ICI and proves cyclosporin is a valid alternative for the treatment of steroid-refractory cases.
- Published
- 2020