Table 1.
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