Pembrolizumab-associated autoimmune haemolytic anaemia

Abstract

Treatment paradigms have recently changed with the introduction of immunotherapy; autoimmune toxicities that can arise are frequently very different from the more familiar chemotherapy toxicities. We present a clinical case of autoimmune haemolytic anaemia (AIHA) secondary to pembrolizumab occurring in a 73-year-old male patient being treated for lung adenocarcinoma, who had received 13 cycles of pembrolizumab. Treatment was immediately stopped and he was treated with high dose steroids to which he responded both clinically and biochemically. There have been prior reports of immunotherapy-associated AIHA with the use of cytotoxic T-lymphocyte-associated antigen-4 inhibitors, such as ipilimumab, but very few reports of programmed death-1 (PD-1)/programmed death-ligand 1 (PDL-1) inhibitor associated AIHA. We highlight a rare case of AIHA as an adverse effect of pembrolizumab, a PD-1 inhibitor. Although unusual, it is important to be vigilant for haematological immune-related adverse events.

Management and Outcomes of Hematological Immune-related Adverse Events: Systematic Review and Meta-analysis

“…We found 377 studies in the database search. After we deleted duplicates and we analyzed full texts, we included 14 case series and 66 individual case reports4,12–98 (Fig. 1).…”

Evans syndrome during pembrolizumab therapy for upper urinary tract cancer

“…A review by Tanios et al demonstrated that the first report on Pem-induced hematologic toxicity was published in 2014. 7 Subsequently, as the indications for Pem have increased, including malignant melanoma, 15,16 non-small cell lung cancer, 17,18 and chronic lymphocytic leukemia, 19 there have been increased in reports of hemolytic anemia as an irAE. Pem is available for renal cell carcinoma and UC; Funabashi et al reported real-life a clinical practice study that demonstrated that grade 3 or higher anemia occurred in 2.9% of patients with advanced UC refractory to cisplatin, 20 with a short mean follow-up of 7.7 months.…”

“…demonstrated that the first report on Pem‐induced hematologic toxicity was published in 2014. 7 Subsequently, as the indications for Pem have increased, including malignant melanoma, 15 , 16 non‐small cell lung cancer, 17 , 18 and chronic lymphocytic leukemia, 19 there have been increased in reports of hemolytic anemia as an irAE. Pem is available for renal cell carcinoma and UC; Funabashi et al .…”