Abstract

The anti-PD1 immune checkpoint inhibitor (CPI) pembrolizumab can induce cancer response by restoring immune surveillance. A rare side effect is aplastic anemia (AA), an immune-mediated bone marrow failure. We report the case of a 44-year-old man with metastatic colorectal cancer who developed severe AA after pembrolizumab. Given the need for immune competence to maintain oncological remission, anti-thymocyte globulin was not proposed, and the sequential treatment with cyclosporine, eltrombopag and danazol led to full hematological recovery. Staining of sequential bone marrow biopsies revealed a marked deposition of IgG and complement fractions as compared to idiopathic AA cases. This case and the literature review remark the challenge of treating severe AA after CPIs, balancing immunosuppression against tumor surveillance.

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Authors

Alessandro Bosi - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

Maria Chiara Di Chio - Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

Marta Bortolotti - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Giorgio Alberto Croci - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Francesco Passamonti - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

Wilma Barcellini - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Bruno Fattizzo - Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

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