Abstract
Ipilimumab is a human monoclonal IgG1 antibody against CTLA-4 that has been shown to prolong the overall survival of advanced melanoma. The most common adverse events associated with ipilimumab are immune-related. Severe hematological toxicity is rare. We report a case of severe neutropenia following ipilimumab therapy that fully resolved after the administration of prednisone, cyclosporine, and anti-thymocyte globulin therapies.
Highlights
We present the case of a 54-year-old man with a T4b N1 M0 cutaneous melanoma located on the dorsum of his right foot
Given the lack of improvement in the neutropenia, he was switched to a regimen of rabbit anti-thymocyte globulin (ATG) at 15 mg/kg IV daily for 4 doses and cyclosporine 2.5 mg/kg IV twice daily that was added to the prednisone at the end of week 14
Studies have shown that the addition of anti-Cytotoxic T-lymphocyte antigen-4 (CTLA-4) monoclonal antibody leads to increased T-cell proliferation, presumably by blocking the interaction of CTLA-4 with its natural ligands CD80 and CD86.2 Ipilimumab is a human monoclonal IgG1 antibody against CTLA-43 that is clinically used for the treatment of advanced melanoma, given studies that have demonstrated its ability to prolong survival
Summary
We present the case of a 54-year-old man with a T4b N1 M0 (stage IIIB) cutaneous melanoma located on the dorsum of his right foot. His absolute neutrophil count (ANC) was 0·0 × 109/L, having been last documented normal 2 weeks prior to the fourth dose of ipilimumab. A bone marrow aspirate and biopsy were obtained 12 weeks after the first ipilimumab infusion (Figure 2).
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