Immune checkpoint Inhibitor-Induced Autoimmune hemolytic anemia in endometrial cancer

Immune checkpoint inhibitors (ICIs) have transformed management of advanced and recurrent endometrial carcinoma (EC). However, as their use increases, so too does the incidence of rare side effects related to their use. Here we describe a patient with stage IVB serous endometrial carcinoma who developed autoimmune hemolytic anemia (AIHA) following her second neoadjuvant cycle of carboplatin, paclitaxel, and dostarlimab. She was hospitalized, requiring multiple blood transfusions, a prolonged steroid course, and rituximab before stabilization of her anemia. Further cycles of chemotherapy without dostarlimab demonstrated good clinical response and did not reproduce AIHA. This case highlights the emerging multidisciplinary challenges that arise with the use of these novel targeted therapies. As the importance of these therapies increases in gynecologic oncologic management, it will be critical for providers to be able to diagnosis and manage their unique side effects.