Hematologic complications of immune checkpoint inhibitors

Area of Science:

• Oncology
• Immunology
• Hematology

Background:

• Immune checkpoint inhibitors (ICIs) are antineoplastic therapies that activate immune cells against cancer.
• Seven ICIs are FDA-approved for various solid tumors and hematologic malignancies.
• Common side effects involve immune-related adverse events due to immune system overactivation.

Purpose of the Study:

• To provide clinicians with a clinical and pathophysiological framework for managing rare hematologic toxicities associated with ICIs.
• To aid in the simultaneous management of cancer and ICI-induced hematologic toxicities.

Main Methods:

• This is a review article, synthesizing existing knowledge.
• It focuses on the pathophysiology and clinical management of ICI-related hematologic toxicities.
• Management strategies are discussed in the context of established autoimmune conditions.

Main Results:

• Hematologic toxicities from ICIs are rare and their mechanisms are not fully understood.
• Management often extrapolates from treatments for autoimmune hemolytic anemia, immune thrombocytopenia, and aplastic anemia.
• Balancing cancer treatment efficacy with managing hematologic toxicity is a key challenge.

Conclusions:

• A structured approach is needed to address ICI-related hematologic toxicities.
• Understanding the underlying immune dysregulation is crucial for effective management.
• Maintaining cancer therapy while managing toxicities requires careful clinical judgment.