Reactions 1680, p257 - 2 Dec 2017 Pure red cell aplasia and cardiac failure: case report A 70-year-old woman developed pure red cell aplasia (PRCA) and cardiac failure during treatment with nivolumab. The woman, who underwent resection of subcutaneous mass in the right axilla, was diagnosed with melanoma of unknown origin. She had received chemotherapy with various drugs. However, she had developed multiple metastases to the to the subcutaneous lymph node, right retroperitoneum and right adrenal gland. Each time, she underwent complete metastasectomy, but developed cardiac metastasis 10 years after the initial examination. She developed cardiac failure 2 years later due to enlargement of the cardiac tumour. Subsequently, she was enrolled in a phase 2 clinical trial of nivolumab (ONO-4538/BMS-936558). She was started on IV nivolumab 2 mg/kg every 3 weeks. Her tumour decreased in size and partial response was maintained for 3 years. After 31 courses of nivolumab and 21 months of administration, she was hospitalised due to severe anaemia and cardiac failure. Her treatment with nivolumab was stopped. Blood test results including RBC count of 1.98 x 10 /µL (ref: 3.59 5.0), haemoglobin of 5.7 g/dL (ref: 11.5 14.0) and haematocrit of 16.8% (ref: 35.0 45.0) revealed normocytic, normochromic anaemia, and reticulocytopenia and all other components were normal. Bone marrow aspiration revealed elevated megakaryocytes and decreased erythroblasts. These findings suggested PRCA. She received prednisone and blood transfusion, and anaemia improved. Also, the cardiac failure, which was caused due to severe anaemia improved with blood transfusion. Her steroid dose was gradually decreased and she did not experience any recurrence of anaemia. Author comment: "There have been several reports of autoimmune [haemolytic anaemia] that developed because of nivolumab . . . however, there were few reports of PRCA that developed because of nivolumab therapy" "Similarly, the cardiac failure caused by the severe anemia was improved with blood transfusions." Yuki A, et al. A case of pure red cell aplasia during nivolumab therapy for cardiac metastatic melanoma. Melanoma Research 27: 635-637, No. 6, Dec 2017. Available from: URL: http://doi.org/10.1097/CMR.0000000000000392 - Japan 803284602 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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