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Evans’ syndrome induced by atezolizumab plus bevacizumab combination therapy in advanced hepatocellular carcinoma

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Abstract

An 86-year-old man presented with recurrence of hepatocellular carcinoma (HCC) after surgery. Atezolizumab plus bevacizumab was initiated. After the third course of atezolizumab plus bevacizumab therapy, petechial purpura appeared on the extremities and trunk. Laboratory tests revealed isolated severe thrombocytopenia without evidence of combined coagulopathy. He was diagnosed with immune thrombocytopenic purpura (ITP), and high-dose immunoglobulin and Helicobacter pylori eradication therapies were administered. Improvement in thrombocytopenia was observed; however, 20 days after the onset of ITP, laboratory data revealed hemolytic anemia. Both direct and indirect Coombs tests were positive, and he was diagnosed with Evan’s syndrome complicated by ITP and autoimmune hemolytic anemia (AIHA) induced by immune-related adverse events (irAEs). After treatment with prednisolone, the hemoglobin level increased, and hemolytic findings improved on blood tests. We encountered a rare case of Evans’ syndrome due to atezolizumab plus bevacizumab therapy for HCC. In atezolizumab plus bevacizumab therapy, hematologic toxicities are not rare adverse events and attention is required.

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Acknowledgements

This study received no funding from public or private sectors.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan

    Masanori Fukushima, Kazuaki Tajima, Ryu Sasaki, Yasuhiko Nakao, Kosuke Takahashi, Eisuke Ozawa, Satoshi Miuma, Hisamitsu Miyaaki & Kazuhiko Nakao

  2. Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

    Takeharu Kato

Authors
  1. Masanori Fukushima
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  2. Kazuaki Tajima
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  3. Ryu Sasaki
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  4. Yasuhiko Nakao
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  5. Kosuke Takahashi
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  6. Eisuke Ozawa
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  7. Satoshi Miuma
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  8. Takeharu Kato
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  9. Hisamitsu Miyaaki
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  10. Kazuhiko Nakao
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Contributions

All the authors contributed to the conception and design of the study. Material preparation, data collection, and analyses were performed by MF, KT, RS, YN, KT, EO, SM, TK, HM, and KN. The first draft of the manuscript was written by MF, and all authors contributed to previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Masanori Fukushima.

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The authors declare that they have no conflict of interest.

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All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient to publish this case report.

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Fukushima, M., Tajima, K., Sasaki, R. et al. Evans’ syndrome induced by atezolizumab plus bevacizumab combination therapy in advanced hepatocellular carcinoma. Clin J Gastroenterol 16, 402–406 (2023). https://doi.org/10.1007/s12328-023-01767-0

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  • DOI: https://doi.org/10.1007/s12328-023-01767-0

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