Agranulocytosis Following Durvalumab Plus Tremelimumab Therapy for Hepatocellular Carcinoma

Agranulocytosis is an extremely rare but potentially fatal immune-related adverse event (irAE) induced by immune checkpoint inhibitors (ICIs). Its management, particularly following combination therapies such as durvalumab/tremelimumab (Dur/Tre) for hepatocellular carcinoma (HCC), is challenging owing to limited data. We herein report a 79-year-old man with HCC who developed severe Dur/Tre-induced agranulocytosis that was refractory to granulocyte colony-stimulating factor, high-dose corticosteroids, and intravenous immunoglobulin. Subsequent treatment with oral cyclosporine (CsA), carefully dosed for liver cirrhosis, achieved complete hematologic recovery. This report details a successful management strategy for this rare, life-threatening irAE, suggesting the potential utility of CsA after initial therapies fail.