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T-cell prolymphocytic leukaemia associated with immune checkpoint inhibitor (pembrolizumab)
  1. Alzira R Avelino1,
  2. Oday Elmanaseer1,
  3. Stephen Wrzesinski1,2 and
  4. Mihir Raval1,2
  1. 1Internal Medicine Department, Albany Medical Center Hospital, Albany, New York, USA
  2. 2New York Oncology Hematology PC, Albany, New York, USA
  1. Correspondence to Dr Alzira R Avelino; avelina{at}


We describe the case of a man in his 60s with squamous cell carcinoma of the lung with brain metastasis treated with pembrolizumab who subsequently developed T-cell prolymphocytic leukaemia. He was transferred to our hospital with worsening dyspnoea, suspected hyperviscosity syndrome and tumour lysis syndrome. He was intubated and admitted to our critical care unit. Emergent leucapheresis was started due to worsening renal function in the setting of tumour lysis and hyperviscosity syndromes. He continued to deteriorate and required continuous renal replacement therapy. Unfortunately, he eventually died from haemodynamic decompensation. There are only a few anecdotal cases pointing at a possible association between the use of immune checkpoint inhibitors and the progression or exacerbation of secondary haematological malignancies. The poor prognosis of these haematological malignancies warrants further investigation to determine if checkpoint inhibitors increase the risk of developing or propagating these potentially fatal diseases.

  • Immunological products and vaccines
  • Haematology (drugs and medicines)
  • Haematology (incl blood transfusion)
  • Immunology
  • Adult intensive care

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  • Contributors AA completed the initial draft of the case including literature review, as well as subsequent editing and drafts. OE did additional literature review as well as document revisions/editing for subsequent drafts. Additional review, editing and mentorship provided by SW and MR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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