Clinicopathological characteristics of pure red cell aplasia induced by immune checkpoint inhibitors in cancer patients

BACKGROUND: This study aims to elucidate the clinical features of pure red cell aplasia (PRCA) induced by immune checkpoint inhibitors (ICIs), with the goal of providing guidance for the prevention, diagnosis, and clinical management of this complication. METHODS: We systematically searched multiple databases, including PubMed, Embase, EBSCO, Scopus, Web of Science, and Google Scholar, and integrated case reports related to ICI-induced PRCA for retrospective analysis. The search period spanned from the initiation of relevant research up to 11 July 2025. RESULTS: This study included 32 patients with PRCA induced by ICIs, with a median age of 57.5 years (25-84 years). The median time to PRCA onset was 3 months (0.7-36 months) after ICI initiation, and the median treatment duration was 4 cycles (1-52 cycles). The main clinical manifestations were anemia and fatigue, with diagnosis confirmed by hematologic laboratory tests and bone marrow biopsy. Upon discontinuation of ICIs, along with transfusion support, systemic glucocorticoid therapy, and, when necessary, intravenous immunoglobulin or other immunosuppressants, the condition of ICI-associated PRCA patients showed significant improvement. CONCLUSION: PRCA induced by ICIs is a rare immune-related adverse event that typically occurs around 3 months after treatment. Early identification and appropriate intervention can lead to favorable outcomes.