Presumed complement-mediated, checkpoint inhibitor-induced, thrombotic microangiopathy in a patient with metastatic melanoma
Autor: | Christopher J. Patriquin, Thiago Pimentel Muniz, Samuel Saibil |
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Rok vydání: | 2023 |
Předmět: |
0301 basic medicine
Oncology Male medicine.medical_specialty Thrombotic microangiopathy medicine.medical_treatment Ipilimumab 03 medical and health sciences 0302 clinical medicine hemic and lymphatic diseases Internal medicine medicine Humans Adverse effect Melanoma Aged business.industry Thrombotic Microangiopathies General Medicine Immunotherapy medicine.disease Complement system 030104 developmental biology Complement Inactivating Agents Nivolumab 030220 oncology & carcinogenesis Skin cancer business medicine.drug |
Zdroj: | BMJ case reports. 14(7) |
ISSN: | 1757-790X |
Popis: | Immune checkpoint inhibitors (ICIs) are associated with a variety of immune-related adverse events (irAEs), but haematological irAEs are rare. We report a case of presumed complement-mediated thrombotic microangiopathy (CM-TMA) in a 78-year-old man with metastatic melanoma following treatment with ICIs. Following two doses of combination nivolumab and ipilimumab therapy, he developed microangiopathic haemolytic anaemia, thrombocytopenia and increased creatinine. ADAMTS13 activity was preserved, CH50 was high, haptoglobin was depleted and a blood film demonstrated fragments. Given this constellation of findings, a diagnosis of CM-TMA was made. Immunotherapy was held and the patient received steroids and supportive care. Six months after his last dose of immunotherapy, he has no evidence of melanoma or CM-TMA. CM-TMA should be suspected in patients on ICI with unexplained anaemia and thrombocytopenia with preserved ADAMTS13 activity. Suspicion of complement dysregulation may have therapeutic implications, such as the necessity of complement pathway inhibition. |
Databáze: | OpenAIRE |
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