Fatal myocarditis and rhabdomyolysis induced by nivolumab during the treatment of type B3 thymoma
Fatal myocarditis and rhabdomyolysis induced by nivolumab during the treatment of type B3 thymoma
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DOI：
10.1080/15563650.2017.1401079
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发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
Liu, Hong-bin
中科院分区：
文献类型：
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作者：
Chen, Qiang;Huang, Dang-Sheng;Liu, Hong-bin
包括程序性死亡-1抑制剂在内的免疫检查点抑制剂是许多类型恶性肿瘤的有前途的药物;然而，它仍然是B3型胸腺瘤的标签外选择。我们首次报告了一例B3型胸腺瘤患者在一次纳武利尤单抗给药后发生致命性心肌炎和横纹肌溶解症。心肌和肌肉活检结果显示广泛的肌细胞损伤、T淋巴细胞浸润和PD-L1强表达，证实了nivolumab相关的免疫相关不良事件（irAE）。血液检查显示血清AChR结合抗体和炎性细胞因子水平升高，此外还观察到异常淋巴细胞亚群。我们的报告表明，在B3型胸腺瘤中给予nivolumab可能导致罕见但致命的心肌炎和横纹肌溶解，过表达的AChR结合抗体和炎性细胞因子可能是irAE的潜在生物标志物。
Immune checkpoint inhibitors including programmed death-1 inhibitors are promising agents for many types of malignancies; however, it is still an off-label choice for type B3 thymoma. We reported for the first time a patient with type B3 thymoma developed fatal myocarditis and rhabdomyolysis after one dose of nivolumab administration. The results from myocardial and muscle biopsies revealed extensive myocyte damage, T-lymphocytic infiltration and strongly expression of PD-L1 which confirmed the nivolumab-related immune-related adverse events (irAEs). The blood tests showed elevated levels of serum AChR-binding antibody and inflammatory cytokines, in addition abnormal lymphocyte subsets were noted. Our report suggested that administration of nivolumab in type B3 thymoma could cause rare but fatal myocarditis and rhabdomyolysis, over-expressed AChR-binding antibody and inflammatory cytokines may be potential biomarkers for irAEs.