A case of autoimmune haemolytic anaemia after 39 cycles of nivolumab

BMJ Case Rep. 2018 Apr 18:2018:bcr2018224608. doi: 10.1136/bcr-2018-224608.

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.

Keywords: haematology (drugs and medicines); lung cancer (oncology); malignant and benign haematology; malignant disease and immunosuppression.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / complications
  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma of Lung
  • Aged
  • Anemia, Hemolytic, Autoimmune / chemically induced*
  • Anemia, Hemolytic, Autoimmune / complications
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use*
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use*
  • Blood Transfusion
  • Erythropoietin / therapeutic use
  • Hemoglobin A
  • Humans
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy*
  • Male
  • Nivolumab
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents
  • Erythropoietin
  • Nivolumab
  • hemoglobin AA
  • Hemoglobin A