First reported use of immune checkpoint inhibitor for treatment of cancer in a patient with acquired hemophilia A

Abstract

• Acquired hemophilia is an autoimmune disorder that is rare but can cause serious, sometimes life-threatening bleeding. • Immune therapy with immune check points inhibitors is a key pillar in treatment of malignancies but can cause autoimmune associated adverse effects including several case reports of causing acquired hemophilia. • Our patient with acquired hemophilia developed lung cancer and was ultimately started on immune checkpoint inhibitor and did not develop relapse of acquired hemophilia and demonstrates the possibility of safely using immune checkpoint inhibitors in patients with acquired hemophilia. Acquired hemophilia A is a rare but serious bleeding disorder that occurs because of neutralizing autoantibodies, also called inhibitors that target coagulation factor VIII (FVIII). Although it is a rare disorder, it has high morbidity and mortality with serious, sometimes life-threatening bleeding, often occurring. Immunotherapy with immune checkpoint inhibitors (ICI) is now a key pillar in treatment of malignancies. They have improved outcomes in malignancy but given their mechanism of action, which stimulates the immune response, autoimmune-associated adverse effects are a concern. Several case reports have identified a risk of AHA occurrence in patients treated with ICI. There are no case reports documenting the use or outcomes of ICI in patients with pre-existing AHA. Here we present the first ever case of a patient with AHA in complete remission treated successfully with ICI for lung cancer without relapse in AHA.