Case Report: Successful Treatment of Steroid-Refractory Immune Checkpoint Inhibitor-Related Pure Red Cell Aplasia With Cyclosporin

Case Report: Successful Treatment of Steroid-Refractory Immune Checkpoint Inhibitor-Related Pure Red Cell Aplasia With Cyclosporin

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Anemia associated with Immune checkpoint inhibitor (ICI) is usually hemolytic and regenerative.Cases of non-regenerative pure red cell aplasia are rare, and typically improve upon drug popularfilm.blog discontinuation and after corticotherapy.We herein report a case of nivolumab-related erythroblastopenia refractory to steroids in a melanoma patient that improved only after treatment with cyclosporin.

Nivolumab had been well tolerated for 2 months after being introduced as an adjuvant treatment.Hemoglobin level then progressively decreased from 12.7 g/dl as baseline value to a nadir of 4.

3 g/dL despite transfusion with a total of 29 packed red blood cells in 3 months.Extensive workup including repeated bone marrow examinations led to the diagnosis of pure red cell aplasia.Anemia persisted despite nivolumab discontinuation and over a month of corticotherapy, but improved dramatically 3 days after cyclosporin initiation and did not recur upon cyclosporin tapering.

The patient remains cancer-free 9 months after nivolumab withdrawal.This case highlights the under-recognized risk of erythroblastopenia in patients treated hacklinkci.com with ICI and proves cyclosporin is a valid alternative for the treatment of steroid-refractory cases.