A case of autosplenectomy associated with T-cell checkpoint inhibitor treatment

Description

A 77-year-old Caucasian man presented to the oncology service with de novo v-raf murine sarcoma viral oncogene homolog B (BRAF), wild-type metastatic melanoma and widespread disease involving; subcutaneous fat, lymph nodes, bone and spleen with no history of autoimmunity. At diagnosis, the spleen was measured within normal limits on CT. In November 2013, he commenced treatment on a phase-III randomised double-blinded clinical trial (CA209-067) and received combination checkpoint inhibitor therapy with ipilimumab and nivolumab.

Radiological mixed response was observed after three months, with a partial response in all target lesions (RECIST V.1.1 criteria) but an increase in the size of the non-target splenic metastasis consistent with pseudoprogression. In conjunction, splenic enlargement was demonstrated (figure 1).

Figure 1

Subsequent restaging coronal abdominopelvic CT demonstrating an increased splenic length of 11.8 cm.

After seven months of immunotherapy, he achieved a complete radiological response to treatment with an...

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