Marked, Lasting Disease Regression and Concomitantly Induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in a Patient With Lung Adenocarcinoma and Autoantibodies Receiving Atezolizumab Plus Chemotherapy: A Case Report

Abstract

Various immune-related adverse events can frequently occur, which may be life-threatening if programmed death 1 or its ligand is blocked. Here, we report a rare case of concomitant autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis caused by atezolizumab plus chemotherapy in a patient with lung adenocarcinoma and autoantibodies. Dramatic and lasting tumor regression in response to only one therapy cycle was achieved. Nevertheless, this case suggests that careful management is required when using immunotherapy in patients with autoantibodies.

Hemophagocytic lymphohistiocytosis (HLH) and cytokine release syndrome (CRS) in a patient with oncogene‐addicted metastatic non‐small cell lung cancer (NSCLC) following combination chemotherapy‐immunotherapy

“…3 HLH as a potential ICI complication has been reported more recently and remains vanishingly rare. 7 8 Disappointingly, this has not been the case for our patient.…”

“…In particular, Endo et al. describe a patient with mNSCLC treated with one cycle of carboplatin/paclitaxel/atezolizumab who developed HLH and autoimmune hemolytic anemia and was noted to have a marked, durable disease response 8 . Disappointingly, this has not been the case for our patient.…”

A Case Report of Hemophagocytic Lymphohistiocytosis and Meningitis Due to Atezolizumab Treatment for Lung Adenocarcinoma

“…Therefore, the combination of HLH and meningitis due to atezolizumab is very rare, making this case very valuable. To the best of our knowledge, there have been two previous case reports of HLH due to atezolizumab, with two cases reported [ 12 , 13 ]. Due to the small number of reports of atezolizumab-induced HLH, the predisposing factors for this disease have not yet been clearly identified.…”

Treatment-related hemophagocytic lymphohistiocytosis due to atezolizumab: a case report and review of the literature

“…To the best of the authors’ knowledge, this is the first case report describing this rare systemic toxicity with sole use of atezolizumab as cancer therapy. Another case has been described, with the use of combination chemotherapy with carboplatin and nab-paclitaxel with atezolizumab, and the addition of autoimmune hemolytic anemia to sHLH [ 22 ]. As in the previous case report, our case is alarming due to the fast development of this deadly complication, after a single infusion of atezolizumab.…”