Case report a case of durvalumab induced aplastic anemia after chemoradiotherapy for NSCLC

Abstract

​A 74-year-old woman with squamous cell lung cancer (cT3N1M0, c-stage IIIA) was treated with durvalumab after chemoradiotherapy. At the beginning of the fourth treatment, Grade 2 (Common Terminology Criteria for Adverse Events ver5.0) radiotherapy-induced pneumonitis occurred, followed by sudden thrombocytopenia of Grade 4 (14,000/μL) a month later, and two weeks later, platelet and white blood cell counts decreased to 1,000/μL and 1,110/μL, respectively. Bone marrow biopsy showed markedly hypoplastic marrow without dysplasia, and we diagnosed aplastic anemia secondary to durvalumab. The patient required frequent granulocyte colony-stimulating factor (G-CSF) injections and platelet transfusions. From the beginning of treatment, the patient responded poorly to platelet transfusions, and anti-human leukocyte antigen (HLA) antibodies were detected. After multidisciplinary treatment, including the use of HLA-matched platelet transfusions, platelets and white blood cells gradually recovered from platelet transfusion dependence approximately two months after the onset of aplastic anemia. Here, we report the first case of durvalumab-induced aplastic anemia.

Keywords

• Durvalumab
• PD-L1
• Aplastic anemia
• Immune-related adverse event