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Carboplatin/pembrolizumab Acute myelomonocytic leukaemia: case report

A 79-year-old man developed acute myelomonocytic leukaemia (AML) during treatment with carboplatin and pembrolizumab for metastatic non-small cell lung cancer [NSCLC; routes not stated; not all dosages stated]. The man presented with a palpable mass on the left side of his neck for 4 weeks. Subsequent analyses led to the diagnosis of NSCLC with multiple metastases to the lymph nodes and rib, stage IVA, T1N3M1b. Therefore, in February 2019, he started receiving carboplatin and gemcitabine. He achieved a partial response after 2 cycles; however, disease progression became evident after 4 cycles. Therefore, in April 2019, he started receiving pembrolizumab 200mg every 3 weeks. He achieved a complete response after 3 cycles (9 weeks); however, on presentation to hospital for cycle 4 of pembrolizumab, he exhibited a markedly elevated WBC count, with symptoms of an upper respiratory tract infection. Therefore, the man’s treatment with pembrolizumab was discontinued. One week following discontinuation of pembrolizumab, his elevated WBC count persisted. Peripheral blood smear analysis revealed 15% blast cells and hypogranulation with monocytosis and basophilia. Therefore, bone marrow biopsy was performed, which revealed an increase in the number of myeloblasts, with 40.92% of nucleated cells. The myeloblasts were found to be positive for MPO, CD11c, CD13 and CD33 expression. Routine cytogenetic analysis demonstrated normal male karyotype. A multiplex, nested reverse transcription PCR assay for AML1/ETO, BCR/ ABL and PML/RARA gene rearrangement associated with acute leukaemia showed no abnormalities. Based on these findings and clinical presentation, he was diagnosed with AML associated with carboplatin and pembrolizumab. Since his WBC count exceeded over 100 000/µL, he started receiving hydroxycarbamide [hydroxyurea] to control the leucocytosis. However, during preparation for induction chemotherapy for AML, chest CT scan revealed diffuse bilateral coalescent opacities. Subsequently, he developed acute respiratory distress syndrome. Eventually, he died due to acute respiratory distress syndrome. Kim H-B, et al. Acute myelomonocytic leukemia during pembrolizumab treatment for non-small cell lung cancer: A case report. World Journal of Clinical Cases 8: 2833-2840, No. 13, 6 Jul 2020. Available from: URL: http://doi.org/10.12998/wjcc.v8.i13.2833

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Reactions 22 Aug 2020 No. 1818