Acquired bleeding disorders secondary to immune checkpoint inhibitors: a case report and systematic literature review

Authors

William J. Archibald, James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry.
Peter A. Kouides, Rochester Regional HealthFollow
Majed A. Refaai, Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Neil A. Lachant, James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry.

Department

Oncology and Hematology

Document Type

Article

Publication Title

Blood Coagulation & Fibrinolysis

Abstract

Acquired bleeding disorders because of an autoimmune phenomenon are rare events. Acquired von Willebrand disease (aVWD) has been estimated as having a prevalence of 400 per million in the general population. Acquired hemophilia A (AHA), the most common of the acquired hemophilias, has an estimated incidence of 1.3-1.5 cases per million per year. Immune checkpoint inhibitors (ICI) targeting PD-1, PD-L1, and CTLA-4 are being used with increasing frequency for hematologic and oncologic disorders. Acquired hemophilias and aVWD have been reported with the use of ICI therapy. We performed a systematic review of the literature to identify cases of acquired bleeding disorders with ICI therapy and contribute our own institution's experience with a case of AHA after pembrolizumab therapy. Six cases of AHA, one case of aVWD, and one case of factor V inhibitor were identified in the literature. Inhibitors were successfully eradicated in five of the eight cases identified. We propose that a centralized registry, possibly through the Scientific and Standardization Subcommittee on Plasma Coagulation Inhibitors through the International Society on Thrombosis and Hemostasis (ISTH), be developed to record treatment and outcomes of this rare ICI complication in order to prognosticate risk and better understand optimal treatment strategies.

First Page

427

Last Page

431

DOI

10.1097/MBC.0000000000001244

Volume

34

Issue

7

Publication Date

10-1-2023

Medical Subject Headings

Humans; Immune Checkpoint Inhibitors; von Willebrand Diseases (complications); Hemostasis; Hemophilia A (complications)

PubMed ID

37695569

Recommended Citation

Archibald, W. J., Kouides, P. A., Refaai, M. A., & Lachant, N. A. (2023). Acquired bleeding disorders secondary to immune checkpoint inhibitors: a case report and systematic literature review. Blood Coagulation & Fibrinolysis, 34 (7), 427-431. https://doi.org/10.1097/MBC.0000000000001244