[A CASE OF AUTOIMMUNE HEMOLYTIC ANEMIA FOLLOWING PEMBROLIZUMAB PLUS LENVATINIB THERAPY FOR METASTATIC RENAL CELL CARCINOMA].

Authors

Soichiro Murayama, Masahiro Matsuki, Makoto Nakamura, Genki Kobayashi, Atsushi Takahashi

Published in

Nihon Hinyokika Gakkai zasshi. The japanese journal of urology. Volume 117. Issue 2. Pages 48-51.

Abstract

Among hematologic immune-related adverse events (irAEs), autoimmune hemolytic anemia (AIHA) is rare and often fatal. We report a fatal case of irAE-associated AIHA that developed more than six months after the first administration of pembrolizumab.The patient was a 70-year-old man who was referred to our department after a thickened pleural lesion was detected on chest radiography performed during follow-up for trigeminal neuralgia. Pathological examination of a biopsy specimen revealed clear cell renal cell carcinoma, and the pleural lesion was diagnosed as a metastasis from renal cell carcinoma. Contrast-enhanced CT demonstrated a tumor extending into the renal vein, para-aortic lymph node metastasis, and right pleural metastasis, leading to a diagnosis of metastatic renal cell carcinoma, cT3aN1M1. Combination therapy with pembrolizumab and lenvatinib was initiated as first-line treatment. After seven courses over approximately six months, disease progression was observed, and cabozantinib was introduced as second-line therapy.About one month after starting cabozantinib, anemia developed, followed by dizziness, prompting emergency hospitalization. Rapid progression of anemia was observed, and the patient was admitted to our hospital. AIHA caused by pembrolizumab-related irAE was suspected, and high-dose corticosteroid pulse therapy was initiated. Although transient improvement was achieved, the anemia acutely worsened again, resulting in cardiac arrest. A total of 14 units of blood transfusion stabilized circulation; however, renal dysfunction and consciousness disturbance secondary to cardiac arrest did not improve, and the patient ultimately died of renal failure.We report this case with a review of the literature, discussing the clinical course and management challenges of AIHA as a delayed hematologic irAE following immune checkpoint inhibitor therapy.

PMID:
42864022
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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