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Case Reports
. 2017 Nov;44(6):426-428.
doi: 10.1159/000479237. Epub 2017 Sep 14.

A Case of Immune Thrombocytopenia as a Rare Side Effect of an Immunotherapy with PD1-Blocking Agents for Metastatic Melanoma

Claudia Pföhler  1 , Hermann Eichler  2 , Barbara Burgard  1 , Nathalie Krecké  1 , Cornelia S L Müller  1 , Thomas Vogt  1
Affiliations
Case Reports

A Case of Immune Thrombocytopenia as a Rare Side Effect of an Immunotherapy with PD1-Blocking Agents for Metastatic Melanoma

Claudia Pföhler et al. Transfus Med Hemother. 2017 Nov.

Abstract

Background: Checkpoint blocking agents such as pembrolizumab or nivolumab may induce a diversity of mostly autoimmune-mediated side effects. These autoimmune phenomena mainly affect ductless glands such as the pituitary gland (hypophysitis), the thyroid gland (thyreoiditis), the skin (vitiligo and rash), the colon (colitis), and the lung (pneumonitis). Furthermore, many other organs or organ systems may be affected.

Case report: This work describes a case of an immune thrombocytopenia that developed or rather became clinically significant shortly after initiation of a systemic therapy with first nivolumab and later pembrolizumab given due to metastatic melanoma. Platelet counts before this systemic therapy were slightly decreased with values around 110/nl (normal value 140-400/nl). Thrombocytopenia developed or became apparent rapidly within 10 days after the first intravenous application of nivolumab and worsened after changeover to pembrolizumab. Therapy had to be stopped due to disease progression and steady aggravation of thrombocytopenia. Immune hematology assays could prove an autoimmune mediated genesis of thrombocytopenia.

Conclusion: Checkpoint inhibitors may induce a multiplicity of mostly autoimmune-mediated side effects. In contrast to chemotherapy-induced cytopenia that results from bone marrow toxicity, thrombocytopenia in melanoma patients treated with checkpoint inhibiting substances seems to result from autoimmune-mediated side effects in the majority of the cases. Thorough laboratory controls during these therapies are therefore required. In case of thrombocytopenia, immune hematology testing to diagnose or rule out immune thrombocytopenia is indispensable.

Keywords: Checkpoint blockade; Immune thrombocytopenia; Melanoma; Nivolumab; Pembrolizumab.

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Figures

Fig. 1
Fig. 1
Platelet counts during and after treatment with PD-1 blockers. Nivolumab was administered on day 3 and 17 (blue arrows); pembrolizumab was given on day 31 and 50 (green arrows). Red arrows indicate corticosteroid applications. X-axis, time in days; y-axis, platelet count/µl blood.
See this image and copyright information in PMC

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