Shaikh Hira, Daboul Nour, Albrethsen Mary, Fazal Salman
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Division of Hematology and Cellular Therapy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2018 Apr 18;2018:bcr-2018-224608. doi: 10.1136/bcr-2018-224608.
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.
随着纳武单抗使用的增加，一些患者出现了罕见但严重的副作用。我们报告一例在接受39个周期纳武单抗治疗后发生的自身免疫性溶血性贫血病例。一名78岁的转移性肺腺癌男性患者，对多线化疗耐药，转而接受纳武单抗治疗。在接受纳武单抗治疗约2年病情稳定后，他出现了输血依赖型贫血，血红蛋白为8.6g/dL。立即停用纳武单抗。骨髓活检结果不能确诊骨髓增生异常综合征。进一步检查提示溶血，血清触珠蛋白<10mg/dL，网织红细胞计数升高，并鉴定出免疫球蛋白G抗体。除每周一次共四剂利妥昔单抗外，开始使用1mg/kg泼尼松后血红蛋白显著改善。接触细胞毒性化疗后出现输血依赖型贫血通常会引发骨髓增生异常综合征的问题。与此相反，我们的患者被诊断为与免疫治疗相关的血液学自身免疫并发症。
