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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue4
Subject Area: Medicine
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DOI: 10.5272/jimab.2026324.7165
Published online: 16 October 2026
Original article
J of IMAB. 2026 Oct-Dec;32(4):7165-7170
HEMATOLOGIC BIOMARKERS AS PREDICTORS OF IMMUNE-RELATED CUTANEOUS ADVERSE EVENTS IN PATIENTS TREATED WITH IMMUNE CHECKPOINT INHIBITORS
Svetoslava Troynaova-Slavkova1,2
, Preslav Vasilev1, Dimitar Slavkov3, Zornitsa Gorcheva4,
1) Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University Pleven, Bulgaria.
2) Clinic of Oncodermatology, University Specialized Hospital for Active Treatment in Oncology “Prof. Ivan Chernozemski”, Sofia, Bulgaria.
3) Department of Neurosurgery, Faculty of Medicine, Medical University Sofia, Bulgaria.
4) Department of Internal Medicine and Oncology, Faculty of Medicine, Medical University Pleven, Bulgaria.
ABSTRACT:
Purpose: The study aimed to evaluate the association between baseline hematologic parameters and the development of immune-related cutaneous adverse events (irCAEs) in patients treated with immune checkpoint inhibitors (ICIs). Identifying predictive biomarkers for cutaneous toxicity is essential for early risk stratification and improved patient management.
Material/Methods: This retrospective observational study included adult patients with solid malignancies who received ICIs (anti–PD-1, anti–PD-L1, or anti–CTLA-4) and developed irCAEs. Data were collected from two oncology centers between 2018 and 2024, including complete blood counts and inflammatory markers: absolute lymphocyte count (ALC), eosinophil count (AEC), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Immune-related cutaneous adverse events were classified by their clinical morphology, and their severity was graded using the Common Terminology Criteria for Adverse Events (CTCAE).
Results: Higher AEC and ALC, along with lower NLR, were significantly associated with the incidence and severity of cutaneous irCAEs. AEC emerged as the strongest predictor (ρ = +0.61, β = +0.52), followed by ALC (ρ = +0.38, β = +0.29) and NLR (ρ = −0.58, β = −0.41). Regression analysis explained 47% of the variance in cutaneous toxicity, and receiver operating characteristic (ROC) analysis showed AEC (AUC = 0.83) and NLR (AUC = 0.76) had strong predictive value.
Conclusions: Baseline AEC, ALC, and NLR are reliable predictors for the development of immune-related cutaneous adverse events in ICI-treated patients. These hematologic markers can serve as accessible, practical tools for early toxicity prediction, allowing for personalized monitoring strategies and timely interventions.
Keywords: Immune checkpoint inhibitors, Cutaneous adverse events, Eosinophil count, Neutrophil-to-lymphocyte ratio, Predictive biomarkers,
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Please cite this article as: Troynaova-Slavkova S, Vasilev P, Slavkov D, Gorcheva Z. Hematologic Biomarkers as Predictors of Immune-Related Cutaneous Adverse Events in Patients Treated with Immune Checkpoint Inhibitors. J of IMAB. 2026 Oct-Dec;32(4):7165-7170. [Crossref - 10.5272/jimab.2026324.7165]
Correspondence to: Svetoslava Troyanova Slavkova, Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University Pleven; 1, Sv. Kliment Ohridski Str., 5800 Pleven, Bulgaria. E-mail: sl_troya@hotmail.com
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Received: 02 May 2026
Published online: 16 October 2026