A 73-year-old woman presented to an otolaryngology clinic with several weeks history of hoarseness. She had significant medical history, and she never smoked. Then, she was suspected lung cancer and she was referred to our hospital. We performed CT scan, PET-CT (positron emission tomography - computed tomography), brain MRI and lymph node biopsy. She was diagnosed with adenocarcinoma of the lungs (cT1aN3M0 stage IIIB programmed death)-1 ligand 100% ) ). Laboratory investigations performed in the department of hematology revealed pancytopenia, and she was diagnosed with aplastic anemia. Pembrolizumab (200 mg/body every 3 weeks) was introduced as first-line therapy for lung cancer after which she improved. Neck lymphadenopathy shrinked in size, but enlarged soon thereafter. Because cancer was limited to left cervical lymph nodes, she received radiotherapy to the left side of her neck. Following radiotherapy, we administered atezolizumab, and lymph node remarkably shrinked in size due to this treatment. Pancytopenia remained but within the acceptable range by the combined administration of eltrombopag.

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In the medical treatment of patients with severe asthma who treatment is required according to pathophysiology, it is important to organize and understand biomarkers. 　In this article, previously reported biomarkers for asthma are classified and organized according to the classification proposed by the FDA-NIH Biomarker Working Group. 　The peripheral blood eosinophil is a biomarker which can be easily measured and widely used from diagnosis to prognosis in severe asthma. In the future, based on the understanding of the characteristics of each biomarker, effective utilization including combination is expected.

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