Pembrolizumab-induced Pure Red Cell Aplasia Successfully Treated with Intravenous Immunoglobulin

Atsushi Isoda; Yuri Miyazawa; Kenichi Tahara; Masahiro Mihara; Akio Saito; Morio Matsumoto; Morio Sawamura

doi:10.2169/internalmedicine.4467-20

CASE REPORTS

Pembrolizumab-induced Pure Red Cell Aplasia Successfully Treated with Intravenous Immunoglobulin

Atsushi Isoda, Yuri Miyazawa, Kenichi Tahara, Masahiro Mihara, Akio Saito, Morio Matsumoto, Morio Sawamura

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Keywords: pure red cell aplasia, pembrolizumab, programed cell death 1, immune-related adverse events, direct anti-globulin test, intravenous immunoglobulin

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 16 Pages 2041-2045

DOI https://doi.org/10.2169/internalmedicine.4467-20

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Abstract

We herein report a 64-year-old man who was treated with pembrolizumab for relapsed Hodgkin lymphoma. After the third administration of pembrolizumab, he showed acute anemia with a positive direct anti-globulin test. Because of the markedly erythroid hypoplasia, he was diagnosed with pure red cell aplasia (PRCA) caused by pembrolizumab. He was initially treated with prednisolone, but the reticulocytes decreased after tapering prednisolone. He then received high-dose intravenous immunoglobulin (IVIG) with prednisolone, and PRCA was successfully treated. Although the pathogenesis of PRCA caused by immune checkpoint inhibitors (CPIs) remains unclear, IVIG treatment may be effective for some steroid-refractory CPI-induced PRCA cases.

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