{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:14:58Z","timestamp":1787764498273,"version":"build-2784847793"},"reference-count":51,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["No. 202540022"],"award-info":[{"award-number":["No. 202540022"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 82272903"],"award-info":[{"award-number":["No. 82272903"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 82403903"],"award-info":[{"award-number":["No. 82403903"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2025,12,9]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) have significantly improved survival outcomes in patients with advanced malignancies. However, their association with immune thrombocytopenia (ITP) poses a critical risk of severe hemorrhage and necessitates treatment discontinuation. The precise molecular mechanisms underlying ICI-associated ITP remain largely unclear, critically impeding the development of predictive biomarkers and targeted therapeutic strategies. Here, we present a case report of an elderly patient with stage IV gastric adenocarcinoma who developed recurrent ITP following programmed death receptor-1 (PD-1) inhibitor serplulimab, trastuzumab and chemotherapy. Notably, longitudinal peripheral blood mononuclear cell samples were collected and subjected to transcriptomic profiling before and after two distinct ITP episodes: the initial occurrence and a recurrence triggered by PD-1 inhibitor rechallenge, providing matched time-resolved data for mechanistic analysis. Our findings demonstrate that ICIs-induced ITP involves a dual pathogenic mechanism combining immune-mediated platelet destruction and intrinsic megakaryopoietic impairment providing a novel conceptual framework for understanding this immunotherapy complication. And this represents the first prospective longitudinal investigation combining serial biospecimen collection with transcriptomic profiling (RNA sequencing) to elucidate mechanisms underlying ICIs-induced ITP.<\/jats:p>","DOI":"10.1136\/jitc-2025-013108","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:45:14Z","timestamp":1767181514000},"page":"e013108","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Mechanistic insights into PD-1 inhibitor-associated immune thrombocytopenia: a case report integrating longitudinal transcriptomic profiling"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5583-2969","authenticated-orcid":false,"given":"Huishan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China"},{"name":"Cancer Center, Zhongshan Hospital 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Zhongshan Hospital Fudan University, Shanghai, Shanghai, China"},{"name":"Cancer Center, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China"},{"name":"Department of Oncology, Zhongshan Hospital (Xiamen), Zhongshan Hospital Fudan University, Xiamen, Fujian, China"},{"name":"Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province, Zhongshan Hospital Fudan University, Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1093-2018","authenticated-orcid":false,"given":"Luoyan","family":"Ai","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China"},{"name":"Cancer Center, Zhongshan Hospital Fudan University, Shanghai, Shanghai, 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