Patients with thrombocytopenia and/or confirmed new-onset ITP following checkpoint inhibitor therapy for melanoma
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 | Case 9 | Case 10 | Case 11 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, years/sex | 52/F | 80/M | 55/F | 44/M | 67/M | 45/F | 53/M | 48/F | 36/F | 56/M | 69/M |
| Checkpoint inhibitor(s) and dosage(s) | Ipi (3 mg/kg) +nivo (1 mg/kg) | Pembro(2 mg/kg) | Ipi (3 mg/kg) + nivo(1 mg/kg) | Ipi(3 mg/kg) | Ipi (3 mg/kg) + nivo(1 mg/kg) | Nivo(3 mg/kg) | Pembro(2 mg/kg) | Pembro(2 mg/kg) | Pembro(2 mg/kg) | Nivo(3 mg/kg) | Nivo(3 mg/kg) |
| Best response to therapy | PR | PR | PR | PD | N/A | PD | N/A | SD | PD | SD | N/A |
| Time to TP onset, days | 15 | 21 | 50 | 62 | 68 | 43 | 12 | 173 | 40 | 130 | 151 |
| Other irAEs | None | Neurological | Endocrine, skin | GI | Neurological, liver | None | Neurological, liver | Skin | None | None | None |
| Counts at TP onset | |||||||||||
| WBC, 103/uLHCT, %PLT, 103/uL | 15.434Less than 5 | 5.843.5104 | 737.861 | 12.8N/A18 | 3.835.886 | 640.749 | 3.735.353 | 11.931.389 | 8.128.258 | 4.94173 | 428.574 |
| % PLT decrease from baseline | 99% | 38% | 80% | 91% | 40% | 84% | 69% | 53% | 74% | N/A | 75% |
| Signs and symptoms of TP | Hematochezia, petechiae, gingival bleeding, epistaxis | None | None | Epistaxis | Bleeding from tumor | None | None | None | None | None | None |
| Confirmation of ITP | Bone marrow biopsy | — | Peripheral smear | — | — | — | — | — | — | — | — |
| Treatment 1/highest PLT | MePRDL + IVIG/18 | None required | None required | Prednisolone + IVIG/30 | Prednisone/118 | Prednisone/307 | None required | None required | None required | None required | None required |
| Treatment 2/highest PLT | Rituximab + prednisone/364 | — | — | None required | None required | aPrednisone/269 | — | — | — | — | — |
Entries with “—” indicate not applicable to patient
Ipi ipilimumab, Nivo nivolumab, Pembro pembrolizumab, PR partial response, PD progression of disease, SD stable disease, N/A not available, TP thrombocytopenia, GI gastrointestinal, irAEs immune-related adverse events, WBC white blood count, HCT hematocrit, PLT platelet, MePRDL methylprednisolone, IVIG intravenous immunoglobulin
aPatient relapsed after initial steroid treatment