60
Treatment
Table 8. Hematologic Toxicities
8.5 Lymphopenia
Workup/Evaluation:
• History (special attention to nutritional status and for lymphocyte depleting therapy
such as fludarabine, ATG, steroids, cytotoxic chemotherapy, radiation exposure, etc.
as well as history of autoimmune disease, family history of autoimmune disease)
• Physical exam with special attention to spleen size
• CBC with differential, peripheral smear, and reticulocyte count
• CXR for evaluation of presence of thymoma
• Bacterial cultures and evaluation for infection (fungal, bacterial, viral — specifically
CMV/HIV)
All Grades • No specific action is required for lymphopenia G1–
G3 and ICPi therapy should be continued.
• For G4 (<250 PB lymphocyte count), continue ICPi
therapy and initiate Mycobacterium avium complex
prophylaxis and Pneumocystis jirovecii prophylaxis,
CMV screening. HIV/Hepatitis screening if not
already done.
• May consider EBV testing if evidence of
lymphadenopathy/hepatitis, fevers, hemolysis occur
c/w lymphoproliferative disease occurs.
8.6 Immune Thrombocytopenia (ITP)
Workup/Evaluation:
• History and physical examination (special attention for history of viral illness and for
lymphocyte depleting therapy such as fludarabine, ATG, steroids, cytotoxic therapy)
• FH of autoimmunity or personal history of autoimmune disease
• CBC, peripheral blood smear, reticulocyte count
• Bone marrow evaluation only if abnormalities in the above testing results and further
investigation is necessary for a diagnosis
• Patients with newly diagnosed ITP should undergo testing for HIV, HCV, HBV, and
H. pylori
• Direct antigen test should be checked to rule out concurrent Evan's syndrome
• Nutritional evaluation
• BM evaluation if other cell lines affected and concern for aplastic anemia
Grading Management
G1: Platelet count 75 to
<100/uL >20,000
• Continue ICPi with close clinical follow-up and
laboratory evaluation.
(cont'd)
