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      Exacerbation of autoimmune hemolytic anemia induced by the first dose of programmed death-1 inhibitor pembrolizumab: a case report.

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          Abstract

          Immune checkpoint inhibitors (ICIs) have demonstrated efficacy against various types of cancers. In addition to immune-related adverse events (irAEs) induced by ICIs, exacerbation of baseline autoimmune disease has been occasionally reported. This is the first report of autoimmune hemolytic anemia (AIHA) exacerbated by pembrolizumab. An 82-year-old Japanese male was diagnosed with lung adenocarcinoma 2 years ago. The patient had chronic anemia with positive direct and indirect Coombs test prior to initiating pembrolizumab therapy at a nearby hospital. However, a definitive diagnosis of AIHA was not made at that time. Seventeen days after the first dose of pembrolizumab, the patient was admitted to the Kobe City Medical Center General Hospital with severe hemolytic anemia (Hb 3.6 g/dL). After thorough examinations including bone marrow biopsy, the patient was diagnosed with pre-existing AIHA exacerbated by pembrolizumab therapy. Two weeks after treatment with prednisone, the levels of hemoglobin became stable with the reduced frequency of blood transfusion and improvements of hemolytic findings on blood tests and the patient was discharged from the hospital. This case report highlighted the importance of determining the patient's pre-existing autoimmune status associated with chronic anemia prior to initiating treatment with ICIs.

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          Author and article information

          Journal
          Invest New Drugs
          Investigational new drugs
          Springer Science and Business Media LLC
          1573-0646
          0167-6997
          June 2018
          : 36
          : 3
          Affiliations
          [1 ] Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
          [2 ] Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan. phyandeth69boo@gmail.com.
          [3 ] Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
          [4 ] Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
          [5 ] Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Hyogo, Japan.
          Article
          10.1007/s10637-018-0561-5
          10.1007/s10637-018-0561-5
          29340837
          7f51502c-1c5b-4311-bc95-f6eb207dc529
          History

          Exacerbation of autoimmune hemolytic anemia,Immune related adverse event,Pembrolizumab,Immune checkpoint inhibitor

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