PMC5319013_01
Checkpoint inhibitor-induced ITP refractory to glucocorticoids subsequently responds to second-line treatment
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Fig1
She was presumed to have new-onset ITP and was started on methylprednisolone and intravenous immunoglobulin (IVIG) (Fig. 1). Seven days after steroids and IVIG, and two days after rituximab, her platelet counts began to improve, reaching normal range (137,000 to 397,000/uL) by one week, and she subsequently did not require additional platelet transfusions (Fig. 1).
Bone marrow from patient with checkpoint inhibitor-induced ITP before rituximab treatment. H&E stained section of the bone marrow biopsy, 100 x magnification. The bone marrow is moderately hypercellular for age with trilineage hematopoiesis and increased megakaryocytes (black arrows) with a range of morphologies and mild clustering. These findings, coupled with the patient's peripheral thrombocytopenia and elevated IPF, are compatible with a diagnosis of ITP
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PMC5319013_01_40425_2017_210_Fig2_HTML.jpg
Fig2
After five days of steroids and IVIG without significant improvement in her platelet count, a bone marrow biopsy revealed a hypercellular marrow with increased megakaryocytes (Fig. 2), further supporting the diagnosis of ITP.
PMC5319013_02