Abstract:

We report a case of severe anemia in a patient with recurrence of ovarian cancer who underwent comprehensive treatment with the immune checkpoint inhibitor (ICI) Tislelizumab combined with the paclitaxel + carboplatin (TC) regimen. The patient's medical history and additional diagnostic tests led to the consideration of autoimmune hemolytic anemia. Following a blood transfusion, administration of high-dose corticosteroids and immunoglobulin, and consistent oral cyclosporine soft capsule maintenance therapy for over 2 months, the individual's hemoglobin concentration gradually increased to 110 g/L. Subsequent monitoring over a 3-month period indicated sustained stability in the hemoglobin levels. In patients receiving ICI therapy combined with cytotoxic chemotherapy or radiotherapy, severe hematological adverse reactions attributed to ICI are very rare among immune-related events. Early diagnosis is challenging, as these reactions can easily be confused with bone marrow suppression caused by radiotherapy and chemotherapy. The earlier use of corticosteroids, the better the treatment outcome and prognosis of adverse reactions caused by ICI. Therefore, when combining clinical anti-tumor therapy with ICI in patients, it is important to pay attention to adverse reactions in the hematologic system and promptly identify them.

Key words: Tislelizumab, Anemia, hemolytic, autoimmune, Immune checkpoint inhibitors, Immune-related adverse events, Case reports