To report a case of severe autoimmune hemolytic anemia (AIHA) induced by pembrolizumab and to discuss an innovative immunosuppressive treatment approach, specifically the combination of cyclophosphamide and fluorouracil with corticosteroids.
Key Findings:
The patient presented with severe anemia, reticulocytosis, elevated lactate dehydrogenase and bilirubin levels, and a positive direct Coombs test, confirming the diagnosis of AIHA.
Initial treatment with corticosteroids and IVIG was insufficient, necessitating the addition of cyclophosphamide and fluorouracil.
After successful management of AIHA, the patient was able to safely continue pembrolizumab treatment without recurrence of AIHA.
Interpretation:
This case highlights the potential for effective management of severe AIHA induced by immune checkpoint inhibitors through a combination of immunosuppressive therapies, suggesting a need for further research.
Limitations:
The findings are based on a single case report, limiting generalizability to broader patient populations.
Further research is needed in larger patient populations to validate the treatment approach and its applicability.
Conclusion:
Timely and appropriate management of pembrolizumab-induced AIHA can allow for safe rechallenge and continuation of immunotherapy in select patients, emphasizing the importance of innovative treatment strategies.
