Contributions
Abstract: PB2015
Type: Publication Only
Background
PD-1 ligand inhibitors are widely used nowadays for treating melanoma, non-small cells lung cancer, head and neck cancer, Hodgkin's lymphoma. Severe hematological side effects of treatment with PD-1 inhibitors (Nivolumab, Pembrolizumab) have only been described in the form of third or fourth degree neutropenia. No cases of isolated thrombocytopenia in connection with PD-1 inhibitor therapy have been reported before.
Presented here is the clinical case of a Hodgkin's lymphoma patient successfully treated with Nivolumab while having developed isolated reversible immune thrombocytopenia.
Aims
The case traces the dynamics of severe immune thrombocytopenia in a female patient with Hodgkin's lymphoma who, despite having developed fourth degree thrombocytopenia, was continually treated with Nivolumab undergoing dose adjustment and Cyclosporine therapy.
Methods
Blood cells count assessment was used to evaluate a single patient’s clinical case within a sixteen-month period of consecutive Nivolumab treatment.
Results
A thirty-eight year-old female diagnosed with stage IIB chemoresistant Hodgkin's lymphoma received PD-1 inhibitor Nivolumab starting September 2016 as immune therapy for her primary condition, at a dose of 3 mg/kg every two weeks. In January 2017, fourth degree thrombocytopenia at count of 3×109/l was detected after 10th injection, accompanied by petechial skin rash on lower extremities. No anemia or leukopenia was found.
Prednisolone pulse therapy with continued administration at a dose of 2 mg/kg per day had no effect within a month. After that, the therapy was supplemented with Cyclosporine at a dose of 3 mg/kg per day, which, at the end of March 2017, was followed by the Nivolumab injection renewal at a dose of 1 mg/kg at the same interval. Cyclosporine was used as an immune suppressor with ability to prevent cytokine gene transcription in activated T-cells.
Further on, the patient demonstrated thrombocyte count increasing to normal and subnormal levels despite continuous treatment with Nivolumab. By the end of September 2017, baseline thrombocyte value was restored, and in accordance with that, the Cyclosporine dose was gradually reduced to a total withdrawal and the Nivolumab dose elevated up to 2 mg/kg per day. To this date (January 22, 2018) the patient remains in full PET-negative remission of Hodgkin's lymphoma. Her thrombocyte count is 167×109/l.
Conclusion
From that clinical case of Hodgkin’s lymphoma patient, we saw that isolated immune thrombocytopenia could not be a sole reason to stop PD-1 inhibitor therapy if adequate measures to mitigate autoimmune activity were taken. Addition of Cyclosporine for our patient suppressed activated T-lymphocytes without reducing the clinical effect of Nivolumab therapy.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Immune thrombocytopenia (ITP), Immunotherapy, Inhibitor
Abstract: PB2015
Type: Publication Only
Background
PD-1 ligand inhibitors are widely used nowadays for treating melanoma, non-small cells lung cancer, head and neck cancer, Hodgkin's lymphoma. Severe hematological side effects of treatment with PD-1 inhibitors (Nivolumab, Pembrolizumab) have only been described in the form of third or fourth degree neutropenia. No cases of isolated thrombocytopenia in connection with PD-1 inhibitor therapy have been reported before.
Presented here is the clinical case of a Hodgkin's lymphoma patient successfully treated with Nivolumab while having developed isolated reversible immune thrombocytopenia.
Aims
The case traces the dynamics of severe immune thrombocytopenia in a female patient with Hodgkin's lymphoma who, despite having developed fourth degree thrombocytopenia, was continually treated with Nivolumab undergoing dose adjustment and Cyclosporine therapy.
Methods
Blood cells count assessment was used to evaluate a single patient’s clinical case within a sixteen-month period of consecutive Nivolumab treatment.
Results
A thirty-eight year-old female diagnosed with stage IIB chemoresistant Hodgkin's lymphoma received PD-1 inhibitor Nivolumab starting September 2016 as immune therapy for her primary condition, at a dose of 3 mg/kg every two weeks. In January 2017, fourth degree thrombocytopenia at count of 3×109/l was detected after 10th injection, accompanied by petechial skin rash on lower extremities. No anemia or leukopenia was found.
Prednisolone pulse therapy with continued administration at a dose of 2 mg/kg per day had no effect within a month. After that, the therapy was supplemented with Cyclosporine at a dose of 3 mg/kg per day, which, at the end of March 2017, was followed by the Nivolumab injection renewal at a dose of 1 mg/kg at the same interval. Cyclosporine was used as an immune suppressor with ability to prevent cytokine gene transcription in activated T-cells.
Further on, the patient demonstrated thrombocyte count increasing to normal and subnormal levels despite continuous treatment with Nivolumab. By the end of September 2017, baseline thrombocyte value was restored, and in accordance with that, the Cyclosporine dose was gradually reduced to a total withdrawal and the Nivolumab dose elevated up to 2 mg/kg per day. To this date (January 22, 2018) the patient remains in full PET-negative remission of Hodgkin's lymphoma. Her thrombocyte count is 167×109/l.
Conclusion
From that clinical case of Hodgkin’s lymphoma patient, we saw that isolated immune thrombocytopenia could not be a sole reason to stop PD-1 inhibitor therapy if adequate measures to mitigate autoimmune activity were taken. Addition of Cyclosporine for our patient suppressed activated T-lymphocytes without reducing the clinical effect of Nivolumab therapy.
Session topic: 17. Hodgkin lymphoma – Clinical
Keyword(s): Hodgkin's Lymphoma, Immune thrombocytopenia (ITP), Immunotherapy, Inhibitor