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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

From: Paraneoplastic hyperleucocytosis in a melanoma patient 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