Cytokine release syndrome after radiation therapy: case report and review of the literature.
Cytokine release syndrome after radiation therapy: case report and review of the literature.
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DOI：
10.1186/s40425-017-0311-9
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发表时间：
2018-01-03
影响因子：
10.9
通讯作者：
D'Angelo SP
中科院分区：
文献类型：
--
作者：
Barker CA;Kim SK;Budhu S;Matsoukas K;Daniyan AF;D'Angelo SP
据报道，在免疫操作后，最常见的是通过治疗性单克隆抗体，细胞因子释放综合征（CRS）。据我们所知，此前尚未有癌症放射治疗 (RT) 后发生 CRS 的报道。放疗后出现的异常临床体征和症状促使我们调查放疗后发生 CRS 的可能性，并回顾了有关该主题的医学文献。一名 65 岁男性患有未经治疗的慢性淋巴细胞白血病和复发性转移性默克尔细胞癌，正在接受抗程序性死亡 1 (PD1) 免疫治疗，被转诊至进展性转移部位进行姑息性 RT。在每周接受 RT 治疗后的几个小时内，他出现发烧、心动过速、低血压、皮疹、呼吸困难和寒战。基于对 CRS 的临床怀疑，在第二次和第三次放疗后 1 小时进行血液细胞因子测量，结果显示肿瘤坏死因子 α (TNF-α) 和白细胞介素 6 (IL-6) 水平比正常值高约十倍。在第三次放疗前，这些指标接近正常，并在放疗后 3 周恢复到正常水平。他经历了受辐射肿瘤的快速消退，随后不久就出现了新的转移部位。文献综述显示癌症放疗后没有出现 CRS 的临床病例。在患有潜在免疫功能障碍的患者中进行抗 PD1 免疫治疗期间的 RT 似乎是免疫过程的假定介质，导致促炎细胞因子显着增加，并产生符合 3 级 CRS 定义的临床症状。该病例证明了放疗引发免疫相关不良事件的能力。
Cytokine release syndrome (CRS) has been reported after immunologic manipulations, most often through therapeutic monoclonal antibodies. To our knowledge, CRS after radiation therapy (RT) for cancer has not been reported before. The development of unusual clinical signs and symptoms after RT led us to investigate the possibility of CRS after RT and review the medical literature on this topic. A 65 year-old man with untreated chronic lymphocytic leukemia and recurrent, metastatic Merkel cell carcinoma undergoing anti-programmed death 1 (PD1) immunotherapy was referred for palliative RT to sites of progressing metastases. Within hours of each weekly dose of RT, he experienced fever, tachycardia, hypotension, rash, dyspnea, and rigors. Based on clinical suspicion for CRS, blood cytokine measurements were performed 1 h after the second and third dose of RT and demonstrated tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels approximately ten-fold higher than normal. These were near normal immediately prior to the third dose of RT, and resolved to normal levels 3 weeks after RT. He experienced rapid regression of irradiated tumors, with development of new sites of metastases soon thereafter. A literature review revealed no clinical cases of CRS after RT for cancer. RT during anti-PD1 immunotherapy in a patient with underlying immune dysfunction appeared to be the putative mediator of an immune process which yielded significant increases in pro-inflammatory cytokines, and produced the clinical symptoms meeting the definition of grade 3 CRS. This case demonstrates the capability of RT to elicit immune-related adverse events.
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影响因子：
7.3
作者：
Saavedra D;Garcia B;Lage A
通讯作者：
Lage A
影响因子：
20.3
作者：
Jitschin, Regina;Braun, Martina;Mougiakakos, Dimitrios
通讯作者：
Mougiakakos, Dimitrios
影响因子：
1.1
作者：
Breslin, Sheila
通讯作者：
Breslin, Sheila
影响因子：
3.4
作者：
Trovo, M.;Giaj-Levra, N.;Ricardi, U.
通讯作者：
Ricardi, U.
DOI：
10.1097/ppo.0000000000000236
发表时间：
2017
期刊：
Cancer journal (Sudbury, Mass.)
影响因子：
--
作者：
Escorcia FE;Postow MA;Barker CA
通讯作者：
Barker CA