Glucocorticoids as adjunctive therapy for severe myelosuppression induced by combined immune checkpoint inhibitor and chemotherapy: a case report and literature review

Objective We conducted a retrospective case series of two lung cancer patients treated at Suining Central Hospital (January–March 2025) who developed severe myelosuppression after immune checkpoint inhibitor (ICI) –chemotherapy combination therapy, to characterize its clinical characteristics and management. Methods A retrospective analysis was conducted. Severe myelosuppression (grade IV, CTCAE 5.0) and pancytopenia (trilineage cytopenia) were clearly defined. Immune-related myelosuppression was diagnosed by exclusion of other etiologies. Clinical data and outcomes were analyzed, and a literature review was performed. Results Both patients with severe myelosuppression after ICI–chemotherapy combination therapy achieved complete hematologic recovery with high-dose glucocorticoids plus standard supportive care. Conclusion Although chemotherapy is the main cause of myelosuppression, severe myelosuppression following ICI–chemotherapy is multifactorial. Clinicians should perform prompt differential diagnosis and consider an immune-related mechanism. Early glucocorticoids are essential if ICI-related toxicity is suspected. As a small retrospective study, further large-scale trials are needed to validate optimal glucocorticoid dosing, duration, and individualized strategies.