Development of Hemolytic Anemia in a Nivolumab-Treated Patient with Refractory Metastatic Squamous Cell Skin Cancer and Chronic Lymphatic Leukemia

Abstract

Management of patients with metastatic squamous cell skin cancer, refractory to initial therapy with standard chemotherapy and radiation protocols, remains difficult with poor overall prognosis and limited therapeutic options. Recently, promising response rates with nivolumab, a programmed death receptor-1-blocking antibody, in squamous cancer of the head and neck have been demonstrated. Considering the similar histological patterns of squamous cell cancer of the skin and squamous cell cancer of the head and neck, we assumed that nivolumab could also be effective in our patients with refractory metastatic squamous cell cancer of the skin. So far, there have been no clinical data on the therapeutic efficacy of nivolumab in squamous cell skin cancer. We here present a case of a patient with metastatic squamous cell skin cancer refractory to previous therapies, who showed a good response to nivolumab over a period of 5 months, but developed a serious hemolytic crisis under nivolumab treatment after eight applications.

Nivolumab-induced cold agglutinin syndrome successfully treated with rituximab

“…There have been a few case reports in the last few years of autoimmune hemolytic anemia (AIHA) that developed after nivolumab therapy in the context of various cancers, and all of them have been reported as warm or mixed AIHA. [6][7][8][9][10][11] To our knowledge, this is the first case report of CAS secondary to nivolumab therapy and in the context of a urothelial carcinoma.…”

Pembrolizumab-Induced Pancytopenia: A Case Report

“…Evidently, 1 patient experienced Grade 4 thrombocytopenia that resulted in death. 8 Schwab et al 9 and Kong et al 10 each described a case of autoimmune hemolytic anemia associated with nivolumab that responded appropriately to corticosteroids. Inadomi et al 11 described a patient in whom bicytopenia developed after nivolumab therapy: Grade 4 anemia and Grade 4 thrombocytopenia.…”

“…[1][2][3] Immune-mediated hematologic toxicity could vary from anemia, thrombocytopenia, and leukopenia to rarely pancytopenia (Table 1). [4][5][6][7][8][9][10][11][12][13][14] We present the first case, to our knowledge, of pembrolizumab-induced pancytopenia to be reported in the literature.…”

Autoimmunhämolytische Anämie als Komplikation der Nivolumab-Therapie

“…Bei der AIHA nach einer Nivolumab-Therapie scheint es sich um eine Wärmeantikörper-AIHA zu handeln, die in der Regel durch IgG vermittelt wird [3,5], wobei in einem Fall sowohl der IgG-als auch der C3-Test positiv ausfielen [4]. In unserem Fall war C3 der ausschließliche Mediator; der IgG-Test war negativ.…”

“…In allen berichteten Fällen erhielten die Patienten Nivolumab entweder in der zweiten oder in der dritten Therapielinie. Die Anämie trat in 2 Fällen nach 2 Zyklen Nivolumab auf [5], in einem Fall nach 5 Zyklen [3] und in einem Fall nach 8 Zyklen [4]. Eine Nivolumabassoziiert AIHA kann also in jeder Therapielinie au treten, entwe- …”