Immune-mediated red cell aplasia after anti-CTLA-4 immunotherapy for metastatic melanoma

Excerpt

A 55-year-old man presented in 2002 with a right lower extremity nodular melanoma, Breslow thickness 1.33 mm, without associated nevus or lymphocytic infiltrate. A sentinel lymph node biopsy was negative, and he received a wide excision and no further therapy. One year later, he presented with a subcutaneous in-transit metastasis which was resected. He began systemic adjuvant therapy on a melanoma vaccine trial containing twelve melanoma peptides in 2004, but 1 year later was found to have progressive disease with liver and subcutaneous metastases. In 2005, he participated in a clinical trial of the fibroblast activation protein (FAP) inhibitor PT100, but developed progressive disease after 6 months, with new subcutaneous and right inguinal lymph node lesions. He continued to have excellent performance status and in late 2005 participated in a phase III trial of carboplatin and paclitaxel along with Sorafenib or placebo, but developed progressive disease after 7 months. In 2006, he began on Ipilimumab (10 mg/kg once every 3 weeks), an anti-CTLA-4 monoclonal antibody, in a phase II clinical trial approved by the Institutional Review Board at the University of Chicago. He did not have a prior personal or family history of autoimmune disease. He developed vitiligo after 3 months of therapy and had radiographic evidence of response, with decreased size of the right inguinal lymph nodes and stable liver metastases. The following month, he developed hypothyroidism, which was successfully treated with levothyroxine. He had intermittent low grade diarrhea managed with kaopectate, and fatigue, but continued to have an active lifestyle with stable disease. …