Immunotherapy-associated autoimmune hemolytic anemia
Background Immunotherapy has been widely used in the treatment of several solid and hematologic malignancies. Checkpoint inhibitors have been the forefront of cancer immunotherapy in recent years. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway are the...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2017-02-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/5/1/15.full |
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| _version_ | 1832540937093382144 |
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| author | Uqba Khan Tarik Hadid Farman Ali Muhammad Siddique Khurram Awais Zaka |
| author_facet | Uqba Khan Tarik Hadid Farman Ali Muhammad Siddique Khurram Awais Zaka |
| author_sort | Uqba Khan |
| collection | DOAJ |
| description | Background Immunotherapy has been widely used in the treatment of several solid and hematologic malignancies. Checkpoint inhibitors have been the forefront of cancer immunotherapy in recent years. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway are the prototypic checkpoint targets for immunotherapy. When combined, CTLA-4 and PD-1 checkpoint inhibitors work synergistically, but with increased probability of toxicity. The following case represents an unusual adverse effect of combined treatment with ipilimumab and nivolumab used for treatment of metastatic melanoma.Case presentation A 43-year-old woman with metastatic melanoma presented with severe generalized weakness and fatigue. She has received two cycles of ipilimumab and nivolumab, last administered 3 weeks prior to her presentation. Initial investigations revealed severe anemia with appropriate reticulocytosis, severely elevated lactate dehydrogenase, undetectable haptoglobin level and positive direct coombs test. Patient was diagnosed with severe autoimmune hemolytic anemia secondary to ipilimumab and nivolumab. She was successfully treated with high dose steroids and rituximab.Conclusions In our case, we present a rare but serious adverse effect of immunotherapy. We illustrate the clinical presentation and management of immunotherapy associated autoimmune hemolytic anemia. Immunotherapy has revolutionized the treatment of many malignant conditions; therefore, it is imperative for health care professionals caring for cancer patient to be familiar with the adverse effects of immunotherapy, which allow for early recognition and management of these potentially lethal side effects. |
| format | Article |
| id | doaj-art-8b41252e32a84575acad8e02f554172d |
| institution | Kabale University |
| issn | 2051-1426 |
| language | English |
| publishDate | 2017-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-8b41252e32a84575acad8e02f554172d2025-02-04T11:30:13ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262017-02-015110.1186/s40425-017-0214-9Immunotherapy-associated autoimmune hemolytic anemiaUqba Khan0Tarik Hadid1Farman Ali2Muhammad Siddique Khurram3Awais Zaka48 Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, Ithaca, New York, USA4Barbara Ann Karmanos Cancer Institute/Wayne State University, Detroit, MI, USAAff1 grid.416413.5Graduate Medical Education, St. John Hospital and Medical Center Detroit MI USAAff1 grid.416413.5Graduate Medical Education, St. John Hospital and Medical Center Detroit MI USAAff2 grid.490189.d0000 0004 0433 2862Department of Internal MedicineHenry Ford Macomb Hospital Clinton Township MI USABackground Immunotherapy has been widely used in the treatment of several solid and hematologic malignancies. Checkpoint inhibitors have been the forefront of cancer immunotherapy in recent years. Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) pathway are the prototypic checkpoint targets for immunotherapy. When combined, CTLA-4 and PD-1 checkpoint inhibitors work synergistically, but with increased probability of toxicity. The following case represents an unusual adverse effect of combined treatment with ipilimumab and nivolumab used for treatment of metastatic melanoma.Case presentation A 43-year-old woman with metastatic melanoma presented with severe generalized weakness and fatigue. She has received two cycles of ipilimumab and nivolumab, last administered 3 weeks prior to her presentation. Initial investigations revealed severe anemia with appropriate reticulocytosis, severely elevated lactate dehydrogenase, undetectable haptoglobin level and positive direct coombs test. Patient was diagnosed with severe autoimmune hemolytic anemia secondary to ipilimumab and nivolumab. She was successfully treated with high dose steroids and rituximab.Conclusions In our case, we present a rare but serious adverse effect of immunotherapy. We illustrate the clinical presentation and management of immunotherapy associated autoimmune hemolytic anemia. Immunotherapy has revolutionized the treatment of many malignant conditions; therefore, it is imperative for health care professionals caring for cancer patient to be familiar with the adverse effects of immunotherapy, which allow for early recognition and management of these potentially lethal side effects.https://jitc.bmj.com/content/5/1/15.full |
| spellingShingle | Uqba Khan Tarik Hadid Farman Ali Muhammad Siddique Khurram Awais Zaka Immunotherapy-associated autoimmune hemolytic anemia Journal for ImmunoTherapy of Cancer |
| title | Immunotherapy-associated autoimmune hemolytic anemia |
| title_full | Immunotherapy-associated autoimmune hemolytic anemia |
| title_fullStr | Immunotherapy-associated autoimmune hemolytic anemia |
| title_full_unstemmed | Immunotherapy-associated autoimmune hemolytic anemia |
| title_short | Immunotherapy-associated autoimmune hemolytic anemia |
| title_sort | immunotherapy associated autoimmune hemolytic anemia |
| url | https://jitc.bmj.com/content/5/1/15.full |
| work_keys_str_mv | AT uqbakhan immunotherapyassociatedautoimmunehemolyticanemia AT tarikhadid immunotherapyassociatedautoimmunehemolyticanemia AT farmanali immunotherapyassociatedautoimmunehemolyticanemia AT muhammadsiddiquekhurram immunotherapyassociatedautoimmunehemolyticanemia AT awaiszaka immunotherapyassociatedautoimmunehemolyticanemia |