免疫检查点抑制剂相关严重贫血一例
Severe Anemia Associated with Immune Checkpoint Inhibitor:A Case Report
杨祖娇 1宁显灵 1刘洲梅 1王文艳 1尹桥仙 1杨谢兰1
作者信息
- 1. 650118 云南省肿瘤医院/昆明医科大学第三附属医院妇科
- 折叠
摘要
报告1例卵巢癌综合治疗后复发应用免疫检查点抑制剂(immune checkpoint inhibitor,ICI)替雷利珠单抗联合紫杉醇+卡铂(TC)方案化疗后出现严重贫血的患者,根据其病史及辅助检查综合考虑为自身免疫性溶血性贫血,经过输血,同时应用大剂量激素,加以免疫球蛋白辅助治疗,并口服环孢素软胶囊维持治疗2个月余,患者血红蛋白逐渐上升至110 g/L,继续追踪其随诊复查情况3个月,血红蛋白水平基本平稳.对于ICI联合细胞毒性化疗或放疗的患者,ICI引起的免疫相关不良反应中血液系统的严重不良反应十分罕见,因早期诊断十分困难,容易跟放化疗导致的骨髓抑制混淆.而ICI引起的不良反应越早使用激素疗效和预后越好.因此,临床对抗肿瘤治疗同时联合应用ICI的患者,需要对血液系统不良反应加以重视和识别.
Abstract
We report a case of severe anemia in a patient with recurrence of ovarian cancer who underwent comprehensive treatment with the immune checkpoint inhibitor(ICI)Tislelizumab combined with the paclitaxel+carboplatin(TC)regimen.The patient's medical history and additional diagnostic tests led to the consideration of autoimmune hemolytic anemia.Following a blood transfusion,administration of high-dose corticosteroids and immunoglobulin,and consistent oral cyclosporine soft capsule maintenance therapy for over 2 months,the individual's hemoglobin concentration gradually increased to 110 g/L.Subsequent monitoring over a 3-month period indicated sustained stability in the hemoglobin levels.In patients receiving ICI therapy combined with cytotoxic chemotherapy or radiotherapy,severe hematological adverse reactions attributed to ICI are very rare among immune-related events.Early diagnosis is challenging,as these reactions can easily be confused with bone marrow suppression caused by radiotherapy and chemotherapy.The earlier use of corticosteroids,the better the treatment outcome and prognosis of adverse reactions caused by ICI.Therefore,when combining clinical anti-tumor therapy with ICI in patients,it is important to pay attention to adverse reactions in the hematologic system and promptly identify them.
关键词
替雷利珠单抗/贫血,溶血性,自身免疫性/免疫检查点抑制剂/免疫相关不良反应/病例报告Key words
Tislelizumab/Anemia,hemolytic,autoimmune/Immune checkpoint inhibitors/Immune-related adverse events/Case reports引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据