Table 1 Clinical course of a female patient with metastatic malignant melanoma (MM) who developed paraneoplastic hyperleucocytosis after initiation of ipilimumab and nivolumab combination therapy
Time | Treatments, interventions | Clinical events |
|---|---|---|
2004, Diagnosis of nodular MM, tumor thickness 1.8 mm, pT2aN0M0, Ib (AJCC 2002) | Sentinel lymph node biopsy negative, Low-dose interferon over 3 weeks, discontinuation due to adverse events | |
2004 to 2007 | Regular clinical follow-up | |
2007 to 2018 | Lost on follow-up | |
3/2018 | Complete work-up including thoracic and abdominal CTs, brain MRT | Admission due to a tumor mass on the right thigh, Asymptomatic singular brain metastasis, and further suspected tumor lesions pectoral, iliacal, inguinal and pulmonal. |
4/2018 | Tumor board recommendation for ipilimumab and nivolumab combination therapy, radiotherapy for bulky tumor mass, patient refused surgery or cyber knife for brain metastatis | |
5/2018 | Two days after starting combination therapy Discontinuation of immunotherapy, radiotherapy started | Admission due to a tumor mass on the right thigh, Massive leukocytosis over 60.000/μl |
About 2 weeks later | Complete work-up including thoracic and abdominal CTs, brain MRT | Hyperleucocytosis up to 122.360/μl |
About 3 weeks later | Continuation of nivolumab monotherapy | Leucocyte counts almost normal |
After 2 weeks | nivolumab monotherapy | general condition worsened and she refused further treatment. |
After 2 weeks | Patient died due to tumor progression |