A case of dual-mechanism immune-related anaemia in a patient with metastatic melanoma treated with nivolumab and ipilimumab.
A case of dual-mechanism immune-related anaemia in a patient with metastatic melanoma treated with nivolumab and ipilimumab.
复制标题
接受纳武单抗和伊匹单抗治疗的转移性黑色素瘤患者出现双重机制免疫相关性贫血的病例。
DOI：
10.1136/jitc-2019-000380
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发表时间：
2020
影响因子：
10.9
通讯作者：
Gajewski,ThomasF
中科院分区：
文献类型：
--
作者：
Olson,DanielJ;Rajagopal,Padma;Tjota,MelissaY;Venkataraman,Girish;Luke,JasonJ;Gajewski,ThomasF
背景免疫检查点抑制剂(ICIS)、ipilimumab和nivolumab的联合应用是选择转移性黑色素瘤患者的主要治疗方法。这一组合还会导致比单独的ICI更频繁的免疫相关不良事件(IrAE)。这些irAEs可能是严重的，其发病机制尚不清楚。病例介绍我们报告了一例女性转移性黑色素瘤患者，联合应用ipilimumab和nivolumab治疗后，出现严重贫血。虽然最初的检查显示为自身免疫性溶血性贫血，但尽管服用了皮质类固醇，贫血仍持续存在，并观察到反常的网织红细胞减少。骨髓活检显示CD8+T细胞介导的红细胞前体的破坏，意味着并发的纯红细胞再生障碍性贫血。这两个过程在加入环孢菌素A后都得到了解决。结论这篇报道描述了一例罕见的同时发生两种血液学IRAE机制的患者，该患者接受了ICI联合治疗。只有在第二个潜在的毒性机制被发现后，才能成功治疗。及时认识到这些罕见的irAEs的罕见表现，现在是有效的IRE管理的关键。
Background The combination of the immune checkpoint inhibitors (ICIs) ipilimumab and nivolumab is a mainstay of treatment for selected patients with metastatic melanoma. This combination also results in more frequent immune-related adverse events (irAEs) than either ICI alone. These irAEs can be severe and their pathogenesis is poorly understood. Case presentation We report a case of a woman with metastatic melanoma, treated with combined ipilimumab and nivolumab, who developed severe anaemia. While initial workup revealed autoimmune haemolytic anaemia, the anaemia persisted despite corticosteroids and paradoxical reticulocytopenia was observed. Bone marrow biopsy demonstrated a CD8+ T cell-mediated destruction of the red cell precursors implying concurrent pure red cell aplasia. Both processes resolved after the addition of cyclosporine A. Conclusions This report describes a rare case of two concurrent mechanisms of haematological irAE in a patient treated with combined ICI therapy. Successful treatment resulted only after the second underlying mechanism of toxicity was uncovered. Prompt recognition of these unusual presentations of rare irAEs is now key to effective irAE management.