Immune thrombocytopenia in patients treated with immune checkpoint inhibitors
Abstract
Abstract Immune checkpoint inhibitor–associated immune thrombocytopenia (ICI-ITP) has been described in case reports and small case series, but comprehensive data on its incidence, risk factors, clinical features, treatment, and outcomes are lacking. We reviewed medical records of all adults initiating ICI therapy between 2016 and 2023 at 29 US hospitals across 7 major cancer centers to identify patients with ICI-ITP. Multivariable logistic regression was used to identify risk factors, and Cox modeling was performed to assess the association between ICI-ITP, its severity, and mortality. Among 86 467 patients, ICI-ITP occurred in 214 (0.25%). Independent risk factors included lower baseline platelet count, combination ICI therapy, stage IV cancer, and additional immune-related adverse events. ICI-ITP occurred at a median of 8 weeks (interquartile range [IQR], 4-18) after ICI initiation, with a median nadir platelet count of 41 × 109/L (IQR, 17 × 109/L to 64 × 109/L). Patients were treated with glucocorticoids (n = 106 [49.5%]), immune globulin (n = 39 [18.2%]), and thrombopoietin receptor agonists (n = 29 [13.6%]). Recovery occurred in 161 patients (75.2%) at a median of 2.3 weeks (IQR, 1.0-5.3). Of 76 patients rechallenged with ICIs, 23 (30.3%) developed recurrent ICI-ITP. ICI-ITP and its severity were associated with higher all-cause mortality, with a nearly threefold increase in risk among patients with severe ICI-ITP than those without ICI-ITP (adjusted hazard ratio, 2.96 [95% confidence interval, 2.14-4.08]). These findings establish ICI-ITP as a rare but clinically significant complication of ICI therapy, provide, to our knowledge, the first large-scale description of its risk factors and clinical course, and underscore the importance of timely recognition and management.
Article Details
Authors (44)
Rebecca K. Leaf
Department of Medicine, Massachusetts General Hospital, Boston
Jodi V. Mones
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Tushar Shenoy
4Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
Mohamed Warsame
5Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN
Marina Beltrami-Moreira
6Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
Sandhya Panch
7Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
Andrew D. Leavitt
9Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
Rebecca L. Zon
2Harvard Medical School, Boston, MA
Ellen K. Kendall
12Department of Medicine, Massachusetts General Hospital, Boston, MA
Sahar Shahamatdar
12Department of Medicine, Massachusetts General Hospital, Boston, MA
Tristan L. Lim
12Department of Medicine, Massachusetts General Hospital, Boston, MA
Can Cui
Debbie Jiang
1Division of Hematology and Oncology, Mass General Brigham Cancer Institute, Boston, MA
Sarah A. Kaunfer
4Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
Lavanya Durai
4Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
Steven T. Hoge
4Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
Julie-Alexia Dias
4Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
Carrie Sha
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Aaron N. Holmes
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Neela Easton
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Elizabeth M. Corley
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Ethan Zhao
3Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Xingyi Li
Amy Spelman
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
Christina Briggs Amos
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
Doris Soebbing
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
Maria Shabih
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
Trevor Jamison
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
Bolun Liu
5Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN
Guleid Hussein
5Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN
Sumeet Yadav
5Department of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN
Mohamed I. Elsaid
Dwight H. Owen
Alexa Meara
17Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
Patrick K. Juras
18Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
Arvind Suresh
Marina Heskel
10Department of Medicine, University of California San Francisco, San Francisco, CA
Jennifer J. Huang
7Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
Ilya G. Glezerman
19Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY
Ronald S. Go
9Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
Kerry L. Reynolds
1Division of Hematology and Oncology, Mass General Brigham Cancer Institute, Boston, MA
Hanny Al-Samkari
Department of Medicine, Massachusetts General Hospital, Boston
Michael H. Kroll
15Section of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX
David E. Leaf
Division of Renal Medicine, Brigham and Women’s Hospital, Boston