Table 1.
Clinical Coursea.
| Week | Treatment/Intervention | Patient’s Symptoms and Clinical Findings | WBC (× 109/L) | ANC (× 109/L) | Hct (%) | Platelet (× 109/L) |
|---|---|---|---|---|---|---|
| 0 | First infusion of ipilimumab (10 mg/kg) | Rash on torso and arms a week after infusion | 5.6 | 3.2 | 42 | 263 |
| 3 | Second infusion of ipilimumab (10 mg/kg) | 8.2 | 4.6 | 45 | 237 | |
| 6 | Third infusion of ipilimumab (10 mg/kg) | 6.7 | 3.3 | 45 | 261 | |
| 9 | Fourth infusion of ipilimumab (10 mg/kg) | Rash improved w/2.5% hydrocortisone cream | 8.3 | 3.5 | 47 | 225 |
| 11 | 6.4 | 1.5 | 44 | 183 | ||
| Sore throat, fevers, dyspnea, and fatigue | 5.1 | 0.0 | 41 | 173 | ||
| 12 | UTI with enterococcus; bone marrow biopsy | 4.0 | 0.0 | 40 | 221 | |
| 13 | Started prednisone 60 mg PO BID | Neutropenic fever | 2.8 | 0.0 | 38 | 238 |
| Cyclosoprine 125 mg PO BID × 5 days; IVIG 40 g IV daily × 4 doses; and filgrastim 5 µg/kg daily × 5 doses started | 2.1 | 0.0 | 34 | 305 | ||
| 14 | Prednisone decreased to 50 mg BID | Perirectal pain | 0.7 | 0.0 | 33 | 223 |
| Prednisone deceased to 40 mg BID | 0.9 | 0.0 | 38 | 203 | ||
| ATG 15 mg/kg daily × 4 doses; cyclosporine 2.5 mg/kg IV BID started | 1.0 | 0.0 | 32 | 130 | ||
| 15 | Perirectal abscess drained | <0.1 | 0.0 | 32 | 127 | |
| Started filgrastim (5 µg/kg SC daily) | 0.2 | 0.0 | 34 | 214 | ||
| 16 | Filgrastim (5 µg/kg SC) | 0.6 | 0.0 | 33 | 248 | |
| Prednisone decreased to 30 mg once daily; filgrastim (5 µg/kg SC) | 1.2 | 0.0 | 35 | 274 | ||
| Filgrastim (5 µg/kg SC) | 6.1 | 0.5 | 34 | 276 | ||
| Filgrastim (5 µg/kg SC) | 18.5 | 5.2 | 34 | 284 | ||
| Prednisone decreased to 20 mg daily | 27.3 | 10.4 | 35 | 263 | ||
| 17 | Prednisone decreased to 10 mg daily | 19.6 | 12.5 | 37 | 158 | |
| Prednisone decreased to 5 mg daily | ||||||
| Prednisone decreased to 5 mg every other day | ||||||
| 18 | 6.2 | 5.2 | 32 | 282 | ||
| 19 | 3.4 | 1.6 | 37 | 385 | ||
| 20 | Prednisone dose increased back to 40 mg PO daily | 2.5 | 0.7 | 39 | 252 | |
| 21 | 3.1 | 2.3 | 40 | 267 | ||
| Prednisone decreased to 30 mg daily | 7.3 | 4.9 | 41 | 239 | ||
| Prednisone 20 mg daily | 8.8 | 6.6 | 43 | 241 | ||
| 24 | Prednisone 10 mg daily | 7.3 | 4.9 | 42 | 232 | |
| 27 | Prednisone 5 mg daily | 7.9 | ||||
| 31 | Prednisone 5 mg every other day | 7.5 | ||||
| 34 | Prednisone stopped | 6.3 | ||||
| 36 | 5.4 |
Abbreviations: WBC, white blood cell; ANC, absolute neutrophil count; Hct, hematocrit; UTI, urinary tract infection; PO, oral; BID, twice daily; IVIG, intravenous immunoglobulin; SC, subcutaneous.
a
The values recorded in boldface fall outside of the normal range.