title: Bi-cytopenia possibly induced by anti-PD-1 antibody for primary malignant melanoma of the esophagus: A case report.
abstract: BACKGROUND
  Anti-programmed cell death 1 antibody nivolumab is a promising agent for various cancers. Immune-related adverse events are recognized; however, bi-cytopenia with nivolumab has not been reported.
  
  
  METHODS
  A 73-year-old man was diagnosed with advanced primary malignant melanoma of the esophagus with liver, lung, and lymph node metastases. Previous therapies including dacarbazine and radiation of 39 Gy to the esophageal region were performed, but the liver metastases deteriorated. The patient was then administered nivolumab (2 mg/kg, every 3 weeks). After 3 cycles, the esophageal tumor and lymph nodes showed marked reductions in size, the lung metastases disappeared, and the liver metastases shrank partially. The treatment continued with 7 cycles for 4 months. However, severe anemia and thrombocytopenia appeared in the 6th cycle, and intermittent blood transfusions were required. The patient received high-dose intravenous methylprednisolone therapy for bi-cytopenia, but it was ineffective. Seven months after the initiation of nivolumab, the patient died of tumor. Although the mechanisms of bi-cytopenia were unclear, it could have been induced by nivolumab.
  
  
  CONCLUSIONS
  The present case shows a rare but serious life-threatening bi-cytopenia possibly associated with nivolumab and suggests the importance of awareness of hematological adverse events during nivolumab therapy.
authors.affiliation: Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University Department of Dermatology, Kyushu University Hospital Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Inadomi
authors.forename: Hozumi
authors.initials: H
authors.lastname: Kumagai
authors.forename: Shuji
authors.initials: S
authors.lastname: Arita
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsuruta
authors.forename: Kotoe
authors.initials: K
authors.lastname: Takayoshi
authors.forename: Koji
authors.initials: K
authors.lastname: Mishima
authors.forename: Shun-Ichiro
authors.initials: SI
authors.lastname: Ota
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yuta
authors.initials: Y
authors.lastname: Okumura
authors.forename: Kosuke
authors.initials: K
authors.lastname: Sagara
authors.forename: Kenta
authors.initials: K
authors.lastname: Nio
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nakano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uchi
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ariyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kusaba
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Niiro
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Koichi
authors.initials: K
authors.lastname: Akashi
authors.forename: Eishi
authors.initials: E
authors.lastname: Baba
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors*; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor