Logo image
Back
A case of autoimmune haemolytic anaemia after 39 cycles of nivolumab
Journal article   Open access   Peer reviewed

A case of autoimmune haemolytic anaemia after 39 cycles of nivolumab

Hira Shaikh, Nour Daboul, Mary Albrethsen and Salman Fazal
BMJ case reports, Vol.2018, p.bcr-2018-224608
04/18/2018
DOI: 10.1136/bcr-2018-224608
PMCID: PMC5911145
PMID: 29669775
url
https://europepmc.org/articles/pmc5911145View
Published (Version of record) Open Access

Abstract

With growing use of nivolumab, rare but serious side effects have surfaced in some patients. We present a case of autoimmune haemolytic anaemia that developed after 39 cycles of nivolumab. A 78-year-old man with metastatic lung adenocarcinoma, refractory to multiple lines of chemotherapy was switched to nivolumab. After around 2 years of stable course on nivolumab, he developed transfusion-dependent anaemia with haemoglobin of 8.6 g/dL. Nivolumab was held immediately. Bone marrow biopsy findings were inconclusive of myelodysplastic syndrome. Further testing was suggestive of haemolysis with haptoglobin <10 mg/dL, elevated reticulocyte count and identification of immunoglobulin G antibody. Haemoglobin improved significantly with initiation of 1 mg/kg prednisone in addition to rituximab weekly × four doses. The development of transfusion-dependent anaemia with the exposure to cytotoxic chemotherapy usually raises the question for myelodysplastic syndrome. In contradiction, our patient was diagnosed to have a haematological autoimmune complication related to immunotherapy.

Details

Metrics

12 Record Views
Logo image