Nivolumab-induced aplastic anemia: A case report and literature review

Area of Science:

• Oncology
• Immunotherapy
• Hematology

Background:

• Immune checkpoint inhibitors, such as programmed cell death-1 (PD-1) receptor inhibitors, represent a significant advancement in cancer therapy.
• These therapies have shown efficacy in various malignancies, including non-small-cell lung cancer and metastatic melanoma, offering improved clinical responses and a better safety profile than traditional chemotherapy.
• While generally well-tolerated, immune checkpoint inhibitors can cause immune-mediated adverse effects, ranging from common symptoms like fatigue and rash to rarer, severe conditions like colitis, pneumonitis, and encephalitis.

Observation:

• This report details a case involving a female patient diagnosed with glioblastoma multiforme.
• The patient received nivolumab, a PD-1 receptor inhibitor, as part of her treatment regimen.

Findings:

• Following treatment with nivolumab, the patient developed aplastic anemia.
• Aplastic anemia is a rare but severe adverse event associated with PD-1 inhibitor therapy.

Implications:

• This case underscores the importance of monitoring for rare but serious hematological adverse events in patients receiving PD-1 inhibitors.
• Further research is warranted to understand the mechanisms underlying PD-1 inhibitor-induced aplastic anemia and to develop strategies for its prevention and management.
• Clinicians should maintain a high index of suspicion for aplastic anemia in patients presenting with symptoms suggestive of bone marrow failure during or after PD-1 inhibitor therapy.