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case_images: Changes in hemoglobin level and T-Bil, LDH after alectinib initiation. About 1 month later, she had grade 2 anemia, which spontaneously improved to baseline. Thereafter, T-Bil and LDH levels gradually increased and, after about 3 years, the hemoglobin level suddenly dropped to 6.4 g/dL. After blood transfusion and discontinuation of alectinib, T-Bil and LDH gradually decreased and hemoglobin level increased.
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case_images: About 2 months after alectinib initiation, grade 2 anemia was observed with an unknown cause (Figure 1). T-Bil and LDH were decreased after hospital discharge (Figure 1). There was no relapse of anemia and no recurrence of lung adenocarcinoma for approximately 10 months after discontinuation of alectinib.
case_images: (A and B) Chest computed tomography prior to initiation of alectinib showed bilateral lymph node metastases. (C and D) Chest computed tomography on admission showed disappearance of bilateral lymph node metastases and no other recurrence of lung cancer.
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case_images: We also confirmed no recurrence of lung cancer and no splenomegaly by whole-body contrast-enhanced CT (Figure 2).   