Clinical characteristics analysis of 4 patients with immune checkpoint inhibitor-related SJS/TEN
Objective To investigate the clinical characteristics of immune checkpoint inhibitor(ICI)-related SJS(Stevens-Johnson syndrome)/TEN(toxic epidermal necrolysis)patients.Methods Clinical data of 4 cases of ICI-related SJS/TEN patients in Peking University Cancer Hospital(Inner Mongolia Campus)from February 2023 to July 2024 were retrospectively collected,and the case characteristics,clinical manifestations,hematological indexes,treatment plans and outcomes of the patients were analyzed.The changes in hematologic indexes before and after thera-peutic plasma exchange were compared.Results Among the 4 ICI-related SJS/TEN patients,there were 3 males and 1 female,all over 60 years old.The onset time of prodromal rash was 2～300 d,with a median time of 90 d.Among them,2 cases were diagnosed with TEN,with adverse reaction grading of G4 and SCORTEN scores of 3 and 5;2 cases were diagnosed with SJS,with adverse reaction grading of G3 and SCORTEN scores of 3 and 2.Three patients experienced bone marrow suppression after chemotherapy,including 2 cases of grade Ⅲ° myelosuppression and 1 case of grade Ⅱ ° myelosuppression,both of which were characterized by a significant decrease in platelet levels.The lym-phocyte counts of all 4 patients significantly decreased,and they discontinued immunotherapy and received plasma ex-change and symptomatic treatment.Three patients recovered from skin toxicity,and one patient died from septic shock.After plasma exchange treatment,the patient's white blood cell count,platelet count,and lymphocyte count in-creased,while the levels of inflammatory markers(C-reactive protein,neutmphil to lymphocyte ratio,platelet to lym-phocyte ratio)decreased.Conclusion Low levels of lymphocytes and high levels of inflammatory markers are predic-tion morkers for ICI-related SJS/TEN and require close monitoring in special populations.The ICI-related SJS/TEN progresses rapidly with high mortality.It is recommended to adopt a multidisciplinary collaboration diagnosis and treat-ment model,perform early plasma exchange,and provide personalized treatment plans.
万方数据
维普
