Table 1 Summary of recently pubmished cases with neutropenia due to immune checkpoint inhibitors
From: Isolated neutropenia as a rare but serious adverse event secondary to immune checkpoint inhibition
Authors | Age, Gender | Cancer type | Immune checkpoint inhibitor | No. of cycles before neutropenia | CTCAE (4.03) Grade/ ANC Nadir /mm3 | Rheumatological/autoimmune disease or serology | Duration of neutropenia | Bone marrow findings | Associated or preceding irAE | Treatment | Outcome | ICI restarted |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Akhtari et al. [9] | 42 Female | Melanoma | Ipilimumab | 4 | G4 ANC - 380 | Antineutrophil and platelet autoantibodies. | 60 days | Normocellular marrow, myeloid hypoplasia. Second bone marrow: hypocellular; granulocytic hypoplasia and lymphohistiocytic aggregates. | Rash | Pegfilgrastim Prednisone Dexamethasone IVIg, Cyclosporine | Prolonged neutropenia with multiple relapses. Recovery of counts after second course of IVIg. Developed anemia and thrombocytopenia | No |
Ban-Hoefen et al. [10] | 54 Male | Melanoma | Ipilimumab | 4 | G4- ANC - 0 | No serology | 52 days | Hypercellular; increase bland histiocytes, lymphocytosis; near complete absence of granulocyte precursors | Rash | Prednisone IVIG, Cyclosporine Filgrastim, Anti-thymocyte globulin (ATG) | Recovery of counts with ATG/cyclosporine/prednisone combination with filgrastim. Steroids tapered off after 4 months. Normal ANC after 6 months. | No |
Tabchi et al. [11] | 74 Female | NSCLC | Nivolumab | 2 | Severe neutropenia likely G-4 (ANC not reported) | Ulcerative colitis in remission | 16 days | Absence of myeloid precursors | Hepatitis | Filgrastim, IVIG Prednisone Methylprednisolone | Responded to high dose methylprednisolone. | No |
Wozniak et al. [12] | 35 Male | Melanoma | Ipilimumab | 3 | G-4 ANC - 0 | No serology | 16 days | Granulocytes with features of rejuvenation and preserved maturation; poorly represented erythrocytes. | Rash | Methylprednisolone Filgrastim (both started after 8 days) | Recovery of counts 16 days. | N/A |
Barbacki et al. [13] | 73 Female | NSCLC | Pembrolizumab | 2 | G-4 ANC-0 | Autoimmune myositis (in remission) Crohn’s disease | 12 days | Not performed | None | GCSF, Methylprednisolone, IVIG, Cyclosporine | Recovered counts after 12 days. No recurrence at 3 months | No |
Sun et al. [14] | 64 Male | Prostate Cancer | Ipilumumab | 2 | G-3 ANC-770 | Weak neutrophil reactive IgM antibodies | 14 days | Not performed | None | Methyl prednisone followed by prednisone | Count recovery with no recurrent neutropenia. PSA remained undetectable and patient started lepurolide | No |
Meti et al. [15] | 59 Male | Melanoma | Ipilimumab/Nivolumab | 2 | G-4 ANC-0 | No serology | 16 days | Variable cellularity, hypoplastic granulocytic, unremarkable erythroid and megakaryocytic lineages. | Rash, hepatitis, colitis | Methylprednisolone, IVIG, filgrastim, mycophenolate mofetil (MMF). | Recovered counts after addition of MMF. | No |
Turgeman et al. [16] | 73 Male | NSCLC | Nivolumab | 5 | G-4 ANC - 0 | Crohn’s disease No serology | 7 days | Not performed | Diarrhea | Methylprednisolone, GCSF | Neutrophils started improving after a week.. | N/A |
|  | 74 Male | NSCLC | Nivolumab | 11 | G4 ANC-0 | Negative Serology | 2 days | Mildly hypercellular, unremarkable erythropoiesis and megakaryopoiesis, hyperplasia of myelocytic precursors | None | G-CSF, prednisolone | Recovered ANC after 2 days. Developed multiple relapses. Placed on Erlotinib, prophylactic GCSF. | No |