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. 2018 Mar 20;7:6. doi: 10.1186/s40164-018-0098-5

Table 1.

Summary of the three available cases of aplastic anemia in the setting of immune checkpoint blockade

Case 1 (present case)a Case 2 [8] Case 3 [9]
Gender/age M/51 F/48 F/57
Oncologic Dx Metastatic melanoma Metastatic melanoma Metastatic GBM
Baseline CBC
 Hb (g/L) 160 N/A ~ 130
 Plt (× 109/L) 250 N/A 268
 Neut (× 109/L) 2.9 N/A ~ 2.5
ICB agent/dose Nivolumab (1 mg/kg) + ipilimumab (3 mg/kg) × 2 cycles Nivolumab (1 mg/kg) + ipilimumab (3 mg/kg) × 4 cycles, N (3 mg/kg) × 5 cycles Nivolumab (3 mg/kg) × 2 cycles
Presentation of AA 15-days post 2nd cycles of nivolumab + ipilimumab 3-days post 5th cycle of nivolumab ~ 14-days post 2nd cycle of nivolumab
CBC @ AA presentation
 Hb (g/L) 77 115 68
 Plt (× 109/L) 346 < 5 5
 Neut (× 109/L) 0.06 < 0.1 0.00
BM biopsy < 10% cellularity with trilineage hypoplasia without excess blasts, myelodysplasia, myeloid/lymphoid precursors or a B cell neoplasm. Lymphocyte fraction 84% T cells with an inverted CD4+:CD8+ ratio (1:2) ~ 10% cellularity, scattered lymphoid and erythroid cells without signs of dysplasia. Absent granulopoiesis and megakaryocytes missing. Majority of lymphoid cells were CD8+ T-lymphocytes Markedly hypocellular marrow with virtual absence of hematopoietic elements. ~ 50% of cells were lymphocutes; majority T-cells. One analyzable metaphase; chromosomally normal
Treatment Methylprednisone 1 mg/kg q 12 h × 7 days, 1 mg/kg q 24 h × 7 days, packed red blood cells Prednisone 1 mg/kg/24 h, G-CSF, infection prophylaxis, tranexamic acid, platelet transfusions Dexamethasone 2 mg PO q 12 h, G-CSF, eltrombopag 50 mg PO q 24 h → 100 mg PO q 24 h, platelet transfusions, packed red blood cells, infection prophylaxis
AA response/outcome Rapid recovery in neutropenia, gradual recovery in hemoglobin No response to treatment No response to treatment
Patient outcome No current active disease, patient being monitored Patient mortality at day 11 of hospitalization from intracerebral hemorrhage Patient mortality 73 days after cycle 2 of Nivolumab

I ipilimumab, N nivolumab

aPatient received one 200 mg dose of lomustine ~ 7 weeks prior