Eosinophilia with Nivolumab

Posted By
cruassan
1/9/2019 1:31pm
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Replies: 8

Hello all, is there anyone who has increase in eosinophils upon therapy with Nivo or Pembro?  I' ve got 14 dose of Nivo and now my eosinophils are 40% ( normal 0-5%)The growth began after the first dose of Nivolumab. And then they grew and grew. Absolute eosinophil count is very high too- 4000. Doctors never faced it. Despite it we continue treatment. Who heared anything about hypereosinophilia with immunotherapy? But  situation is not about increase 10-20%, but 40% It's too much((

Hi Cruassan, I was recently looking into this myself as my eosinophils have been rising since I started the Ipi/Nivo combo. I too asked my oncologist about it and she wasn’t concerned but also didn’t think it really meant anything related to my treatment. I, however, got to looking around and of course found lots of good information from research studies and on Bubbles’ blog. Search for eosinophils on there and you’ll see what I’m talking about. The web address is http://chaoticallypreciselifeloveandmelanoma.blogspot.com/?m=1 .

You should certainly read some of the research studies yourself but it looks like rising eosinophils can be a sign that your body is responding to treatment. I hope that’s true for you.

Take care!

Amanda

Stage IV — one brain met (resected via craniotomy 3/1/18 and subsequently treated with SRS) and two lung mets. Started Opdivo 4/16/18. Opdivo not eliminating lung mets, so on 12/5/18 started Ipi/Nivo combo.

cruassan - (1/10/2019 - 4:00am)

Amanda, thanx a lot! I looked through all science articles and they are encouraging. I'll hope that it's true and it will be good for me. I just couldn't find anyone who has the same blood counts. But many people had immune respons to treatment and they didn't have hypereosinophilia.

Anonymous - (1/9/2019 - 4:47pm)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852343/

Here is an antricle that maybe comes to the conclusion that you may have a better outcome with the high eosinphils.  I didn't get into to that heavily, but ti may be a positive repsonse to the immunotherapy.  Hopefulyl someone else repsonds that has more knowledge on the subject.

cruassan - (1/10/2019 - 4:02am)

Yes, thank you for reply. I'll try not to think about stopping treatment because of such high level of eosinophils.

Hi there Cruassan, there is an up to date article on IRAE's written by Dr. Postow and Dr. Wolchok of Memorial Sloan Kettering that is pretty good at covering all the issue ( See link below). If you look near the beginning there is a heading called "Special Consideration" it talks about risk of opportunistic infections when on immunotherapies. It might be worth asking your oncology team about possible bacterial infection since elevated eosinophils seem to have a link to bacterial enfections. Best Wishes!!! Ed https://www.uptodate.com/contents/patient-selection-criteria-and-toxicit...

cruassan - (1/10/2019 - 4:07am)

Hmm, it's very interesting...I'll show this opinion to my oncologists next Monday. I think if any bacterial infection is, so other blood counts would be changed. But my blood test is absolutely ok. Anyway we'll see what they say.

Amanda's right!  I've posted lots of articles re: eosinophilia.  Here's a direct link to them:  https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=eosinophils  

I wish you my best.  Celeste

cruassan - (1/10/2019 - 6:32am)

Thank you Celeste for support! I'll hope this. Hope is the only thing I've left. My story is very unusual. Nobody could diagnose it. Mixed desmoplastic melanoma with ephiteliod component. 7mm!!(((((( Germany said " Sorry, we never seen this before". Israel could recognise it, but they confirmed that it's very rare and unusual case.