No need to hesitate: immune-related neutropenia and thrombocytopenia that improved by corticosteroids

Unlike cytotoxicity, haematological toxicity is a rare immune-related adverse event that is occasionally irreversible and refractory. A 67-year-old man was diagnosed with advanced lung squamous cell carcinoma. After 41 cycles of nivolumab as third-line chemotherapy, the patient developed severe neutropenia and thrombocytopenia. The bone marrow biopsy and serum immunological tests indicated no evidence of bone marrow failure and suggested autoimmune mature blood cell destruction. After initiating treatment with prednisolone 50 mg orally and filgrastim 75 μg subcutaneously once daily, neutropenia and thrombocytopenia recovered within four and nine days, respectively. The filgrastim was discontinued four days later, and the corticosteroid was discontinued three months later; there has been no haemocytopenia recurrence since then. The patient has remained untreated for more than two years without progression of lung cancer. In conclusion, corticosteroids should be considered for the treatment of autoimmune haemocytopenia if refractory bone marrow dysplasia can be ruled out.