Pure Red Cell Aplasia Induced by Atezolizumab in a Patient with Small-Cell Lung Cancer Successfully Treated with Steroid Therapy: A Case Report
Abstract Introduction: Combination therapy of atezolizumab and chemotherapy has become the standard treatment for small-cell lung cancer. Immune-related adverse events (irAEs) can occur during immune checkpoint inhibitor administration. A few reports exist on pure red cell aplasia (PRCA) as an irAE...
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| Veröffentlicht in: | Case Reports in Oncology 2023-01, Vol.16 (1), p.1592-1597 |
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| creator | Kawakado, Keita Ito, Shunsuke Kono, Kento Mitarai, Yuki Yanagawa, Takashi Nagasaki, Makoto |
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Introduction: Combination therapy of atezolizumab and chemotherapy has become the standard treatment for small-cell lung cancer. Immune-related adverse events (irAEs) can occur during immune checkpoint inhibitor administration. A few reports exist on pure red cell aplasia (PRCA) as an irAE after atezolizumab treatment. PRCA is characterized by normocytic-normochromic anemia, a marked decrease in reticulocytes, and a decrease in bone marrow erythroblasts. Here, we report a case of atezolizumab-induced PRCA. Case Presentation: A 69-year-old male patient was brought to the emergency department with the chief complaint of seizures. Multiple metastatic brain tumors and a mass suspected to be the primary lesion in the right hilar region were observed. After a brain biopsy, he was diagnosed with small-cell lung cancer (cT1cN0M1c stage IVB). He received four courses of carboplatin, etoposide, and atezolizumab in combination with whole-brain irradiation, which led to a partial response. After six courses of atezolizumab maintenance therapy, severe anemia (hemoglobin, 3.4 g/dL) was observed. PRCA induced by atezolizumab was diagnosed using a bone marrow biopsy performed during red blood cell transfusion. Treatment was started with prednisolone 25 mg/day (0.5 mg/kg/day). Anemia improved, and the dose was gradually reduced to 5 mg/day. Conclusion: Reports of PRCA as an irAE are rare but important; hence, we reported this case. |
| doi_str_mv | 10.1159/000535468 |
| format | Article |
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Introduction: Combination therapy of atezolizumab and chemotherapy has become the standard treatment for small-cell lung cancer. Immune-related adverse events (irAEs) can occur during immune checkpoint inhibitor administration. A few reports exist on pure red cell aplasia (PRCA) as an irAE after atezolizumab treatment. PRCA is characterized by normocytic-normochromic anemia, a marked decrease in reticulocytes, and a decrease in bone marrow erythroblasts. Here, we report a case of atezolizumab-induced PRCA. Case Presentation: A 69-year-old male patient was brought to the emergency department with the chief complaint of seizures. Multiple metastatic brain tumors and a mass suspected to be the primary lesion in the right hilar region were observed. After a brain biopsy, he was diagnosed with small-cell lung cancer (cT1cN0M1c stage IVB). He received four courses of carboplatin, etoposide, and atezolizumab in combination with whole-brain irradiation, which led to a partial response. After six courses of atezolizumab maintenance therapy, severe anemia (hemoglobin, 3.4 g/dL) was observed. PRCA induced by atezolizumab was diagnosed using a bone marrow biopsy performed during red blood cell transfusion. Treatment was started with prednisolone 25 mg/day (0.5 mg/kg/day). Anemia improved, and the dose was gradually reduced to 5 mg/day. Conclusion: Reports of PRCA as an irAE are rare but important; hence, we reported this case.</description><identifier>ISSN: 1662-6575</identifier><identifier>EISSN: 1662-6575</identifier><identifier>DOI: 10.1159/000535468</identifier><identifier>PMID: 38111856</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Anemia ; atezolizumab ; Biopsy ; Blood ; Bone marrow ; Brain cancer ; Cancer therapies ; Care and treatment ; Case Report ; Case reports ; Causes of ; Chemotherapy ; Conflicts of interest ; Diagnosis ; Drug dosages ; Drug therapy ; Hematology ; Hemoglobin ; Immunoglobulins ; Immunotherapy ; Lung cancer ; Lung cancer, Small cell ; Magnetic resonance imaging ; Medical prognosis ; Melanoma ; Metastasis ; Monoclonal antibodies ; Pure red cell aplasia ; small-cell lung cancer ; Steroids ; Targeted cancer therapy ; Tomography ; Tumors</subject><ispartof>Case Reports in Oncology, 2023-01, Vol.16 (1), p.1592-1597</ispartof><rights>2023 The Author(s). Published by S. Karger AG, Basel</rights><rights>2023 The Author(s). Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2023 S. Karger AG</rights><rights>2023 The Author(s). Published by S. Karger AG, Basel. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at: https://uk.sagepub.com/en-gb/eur/reusing-open-access-and-sage-choice-content</rights><rights>2023 The Author(s). Published by S. Karger AG, Basel 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10727514/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10727514/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,27635,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38111856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kawakado, Keita</creatorcontrib><creatorcontrib>Ito, Shunsuke</creatorcontrib><creatorcontrib>Kono, Kento</creatorcontrib><creatorcontrib>Mitarai, Yuki</creatorcontrib><creatorcontrib>Yanagawa, Takashi</creatorcontrib><creatorcontrib>Nagasaki, Makoto</creatorcontrib><title>Pure Red Cell Aplasia Induced by Atezolizumab in a Patient with Small-Cell Lung Cancer Successfully Treated with Steroid Therapy: A Case Report</title><title>Case Reports in Oncology</title><addtitle>Case Rep Oncol</addtitle><description>Abstract
Introduction: Combination therapy of atezolizumab and chemotherapy has become the standard treatment for small-cell lung cancer. Immune-related adverse events (irAEs) can occur during immune checkpoint inhibitor administration. A few reports exist on pure red cell aplasia (PRCA) as an irAE after atezolizumab treatment. PRCA is characterized by normocytic-normochromic anemia, a marked decrease in reticulocytes, and a decrease in bone marrow erythroblasts. Here, we report a case of atezolizumab-induced PRCA. Case Presentation: A 69-year-old male patient was brought to the emergency department with the chief complaint of seizures. Multiple metastatic brain tumors and a mass suspected to be the primary lesion in the right hilar region were observed. After a brain biopsy, he was diagnosed with small-cell lung cancer (cT1cN0M1c stage IVB). He received four courses of carboplatin, etoposide, and atezolizumab in combination with whole-brain irradiation, which led to a partial response. After six courses of atezolizumab maintenance therapy, severe anemia (hemoglobin, 3.4 g/dL) was observed. PRCA induced by atezolizumab was diagnosed using a bone marrow biopsy performed during red blood cell transfusion. Treatment was started with prednisolone 25 mg/day (0.5 mg/kg/day). Anemia improved, and the dose was gradually reduced to 5 mg/day. Conclusion: Reports of PRCA as an irAE are rare but important; hence, we reported this case.</description><subject>Anemia</subject><subject>atezolizumab</subject><subject>Biopsy</subject><subject>Blood</subject><subject>Bone marrow</subject><subject>Brain cancer</subject><subject>Cancer therapies</subject><subject>Care and treatment</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Causes of</subject><subject>Chemotherapy</subject><subject>Conflicts of interest</subject><subject>Diagnosis</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Hematology</subject><subject>Hemoglobin</subject><subject>Immunoglobulins</subject><subject>Immunotherapy</subject><subject>Lung cancer</subject><subject>Lung cancer, Small cell</subject><subject>Magnetic resonance imaging</subject><subject>Medical prognosis</subject><subject>Melanoma</subject><subject>Metastasis</subject><subject>Monoclonal antibodies</subject><subject>Pure red cell aplasia</subject><subject>small-cell lung cancer</subject><subject>Steroids</subject><subject>Targeted cancer therapy</subject><subject>Tomography</subject><subject>Tumors</subject><issn>1662-6575</issn><issn>1662-6575</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DOA</sourceid><recordid>eNptkktr3DAUhU1padK0i-5LEWTVxaR6WLLUTRmGPgYGEpLpWkjy1YxSj-XIdsvkT_QvV4nTIYGihcS553xcXW5RvCX4jBCuPmKMOeOlkM-KYyIEnQle8eeP3kfFq76_xlgoLvjL4ohJQojk4rj4czEmQJdQowU0DZp3jemDQcu2Hl0W7R7NB7iNTbgdd8ai0CKDLswQoB3Q7zBs0dXONM3sPrwa2w1amNZBQlejc9D3fmyaPVonMEOmTYEBUgw1Wm8hmW7_Cc1zpr_roYtpeF288Kbp4c3DfVL8-Pplvfg-W51_Wy7mq5njhA0zzoUHJy2TopSSYctLpyxUClRdCqWIpK5y3nmCKacqK7hkNgeosM7Vlp0Uy4lbR3OtuxR2Ju11NEHfCzFttElDcA3oqnQ1syBVRWnprZVMWUKoNdaA8NRk1ueJ1Y12B7XLs0mmeQJ9WmnDVm_iL01wRStOykw4fSCkeDNCP-jrOKY2D0DT3DlRDDOVXWeTa2NyW6H1MdNcPjXsgost-JD1eVUJWVLKqxz4MAVcin2fwB96IljfbY4-bE72vn_8iYPz36pkw7vJ8NOkDaSD4ZA__W95cXk-OXRXe_YXPCbTcg</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Kawakado, Keita</creator><creator>Ito, Shunsuke</creator><creator>Kono, Kento</creator><creator>Mitarai, Yuki</creator><creator>Yanagawa, Takashi</creator><creator>Nagasaki, Makoto</creator><general>S. 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Introduction: Combination therapy of atezolizumab and chemotherapy has become the standard treatment for small-cell lung cancer. Immune-related adverse events (irAEs) can occur during immune checkpoint inhibitor administration. A few reports exist on pure red cell aplasia (PRCA) as an irAE after atezolizumab treatment. PRCA is characterized by normocytic-normochromic anemia, a marked decrease in reticulocytes, and a decrease in bone marrow erythroblasts. Here, we report a case of atezolizumab-induced PRCA. Case Presentation: A 69-year-old male patient was brought to the emergency department with the chief complaint of seizures. Multiple metastatic brain tumors and a mass suspected to be the primary lesion in the right hilar region were observed. After a brain biopsy, he was diagnosed with small-cell lung cancer (cT1cN0M1c stage IVB). He received four courses of carboplatin, etoposide, and atezolizumab in combination with whole-brain irradiation, which led to a partial response. After six courses of atezolizumab maintenance therapy, severe anemia (hemoglobin, 3.4 g/dL) was observed. PRCA induced by atezolizumab was diagnosed using a bone marrow biopsy performed during red blood cell transfusion. Treatment was started with prednisolone 25 mg/day (0.5 mg/kg/day). Anemia improved, and the dose was gradually reduced to 5 mg/day. Conclusion: Reports of PRCA as an irAE are rare but important; hence, we reported this case.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>38111856</pmid><doi>10.1159/000535468</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anemia atezolizumab Biopsy Blood Bone marrow Brain cancer Cancer therapies Care and treatment Case Report Case reports Causes of Chemotherapy Conflicts of interest Diagnosis Drug dosages Drug therapy Hematology Hemoglobin Immunoglobulins Immunotherapy Lung cancer Lung cancer, Small cell Magnetic resonance imaging Medical prognosis Melanoma Metastasis Monoclonal antibodies Pure red cell aplasia small-cell lung cancer Steroids Targeted cancer therapy Tomography Tumors |
| title | Pure Red Cell Aplasia Induced by Atezolizumab in a Patient with Small-Cell Lung Cancer Successfully Treated with Steroid Therapy: A Case Report |
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