Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2833-2840
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2833
Acute myelomonocytic leukemia during pembrolizumab treatment for non-small cell lung cancer: A case report
Hong-Beum Kim, Sang-Gon Park, Ran Hong, Seong-Ho Kang, Yong Sub Na
Hong-Beum Kim, Department of Premedical Course, Chosun University School of Medicine, Gwangju 61452, South Korea
Sang-Gon Park, Department of Hemato-oncology, Chosun University Hospital, Gwangju 61453, South Korea
Ran Hong, Department of Pathology, Chosun University Hospital, Gwangju 61453, South Korea
Seong-Ho Kang, Department of Laboratory Medicine, Chosun University Hospital, Gwangju 61453, South Korea
Yong Sub Na, Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju 61453, South Korea
Author contributions: Kim HB was a major contributor to the writing of the manuscript; Park SG revised the manuscript; Hong R interpreted the histologic findings; Kang SH interpreted the blood smear and bone marrow biopsy findings; Na YS revised and approved the manuscript.
Supported by the National Research Foundation of Korea, funded by the Ministry of Science, ICT, and Future Planning, No. NRF-2015R1A5A2009070.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Dr. Kim reports grants from the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning, No. NRF-2015R1A5A2009070, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Sub Na, MD, Assistant Professor, Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, South Korea. ebusters@chosun.ac.kr
Received: February 14, 2020
Peer-review started: February 14, 2020
First decision: May 26, 2020
Revised: May 29, 2020
Accepted: June 17, 2020
Article in press: June 17, 2020
Published online: July 6, 2020
Abstract
BACKGROUND

Pembrolizumab is a highly selective IgG4 kappa isotype monoclonal antibody against the programmed cell death-1 (PD-1) molecule. In the treatment of non-small cell lung cancer (NSCLC), pembrolizumab has demonstrated significant efficacy, significant survival outcomes, long-lasting responses, and a good safety profile compared with cytotoxic chemotherapy.

CASE SUMMARY

A 79-year-old Korean male presented with a left side palpable neck mass. An ultrasound-guided core-needle biopsy of the largest neck mass was performed, and squamous cell carcinoma was confirmed based on the histological and immunohistochemical findings. He was diagnosed with squamous cell carcinoma of the lung with multiple lymph nodes and rib metastases (T1N3M1b, Stage IVA) using enhanced chest computed tomography and 18F-fluorodeoxyglucose positron emission/computed tomography. After 4 cycles of gemcitabine and carboplatin, we clinically judged the disease as progressive. Owing to the high PD-1 expression demonstrated by the patient, pembrolizumab was initiated (200 mg every 3 wk). After 3 cycles of pembrolizumab, a complete response was achieved. At the 4th cycle of pembrolizumab, the white blood cell count was markedly elevated. Peripheral blood smear analysis and bone marrow biopsy were performed. The patient was diagnosed with acute myelomonocytic leukemia.

CONCLUSION

We present the first report of acute myelomonocytic leukemia during pembrolizumab treatment in an NSCLC patient; the mechanism remains unknown.

Keywords: Acute myeloid leukemia, Immunotherapy, Non-small cell lung cancer, Adverse events, Case report

Core tip: In the treatment of non-small cell lung cancer (NSCLC), pembrolizumab has demonstrated significant efficacy, significant survival outcomes, long-lasting responses, and good safety profile. To the best of our knowledge, this is the first report of acute myelomonocytic leukemia during pembrolizumab in a patient with NSCLC. However, the precise underlying mechanism remains unknown.