Autoimmune hemolytic anemia after 39 cycles of nivolumab for metastatic lung cancer
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Subtype
- Adenocarcinoma
- Sex
- Male
- Spread to
- liver, bone
- Treatment
- chemotherapy, targeted therapy and immunotherapy
- Outcome
- Living With Cancer
Treatment course, step by step
- Received several chemotherapy regimens, including pemetrexed plus carboplatin, carboplatin plus paclitaxel and bevacizumab, docetaxel, and gemcitabine plus vinorelbine.
- Started nivolumab 3 mg/kg every 2 weeks after progression in September 2015 and completed 39 cycles.
- Nivolumab was held after autoimmune hemolytic anemia.
- Received prednisone 1 mg/kg/day plus 4 weekly rituximab doses, with recovery of hemoglobin.
What happened, in summary
A 78-year-old man was diagnosed with Stage IV lung adenocarcinoma in January 2014, with metastases to the liver and bone. His earlier history also included treated Stage II prostate cancer, but the treatment pathway here is specific to his lung cancer.
He first received pemetrexed with carboplatin, followed by carboplatin, paclitaxel and bevacizumab. Later treatment lines included docetaxel, then gemcitabine with vinorelbine. When the lung cancer progressed in September 2015, he started nivolumab at 3 mg/kg every 2 weeks.
He completed 38 nivolumab cycles without major complications. After cycle 39, his hemoglobin fell to 8.6 g/dL from a baseline of 11–13 g/dL, with laboratory findings supporting hemolysis. Nivolumab was held. A lower-dose prednisone course did not correct the anemia, so treatment was intensified to prednisone 1 mg/kg/day plus rituximab weekly for 4 doses.
His hemoglobin improved to 11.1 g/dL by completion of rituximab and later reached 14.6 g/dL about 4 months after high-dose treatment began. Nivolumab remained on hold, while CT imaging and clinical assessment showed stable lung cancer. Re-challenge with nivolumab was being considered.
Where this story comes from
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
How we source and attribute stories Accuracy and limitations
Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Bevacizumab for Lung Cancer 37 stories
These are lay summaries of published cancer stories, for information only. No two cancers behave the same way, and nothing here predicts your own diagnosis or replaces advice from your oncology team. Read the full disclaimer