马抗胸腺细胞球蛋白（ATGAM）成功用于治疗纳武单抗治疗继发的暴发性心肌炎。
Successful use of equine anti-thymocyte globulin (ATGAM) for fulminant myocarditis secondary to nivolumab therapy.
作者信息
Tay Rebecca Y, Blackley Elizabeth, McLean Catriona, Moore Maggie, Bergin Peter, Gill Sanjeev, Haydon Andrew
机构信息
Department of Medical Oncology, Alfred Health, Melbourne, Victoria 3004, Australia.
Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria 3004, Australia.
出版信息
Br J Cancer. 2017 Sep 26;117(7):921-924. doi: 10.1038/bjc.2017.253. Epub 2017 Aug 10.
BACKGROUND
Immune-mediated myocarditis is an uncommon adverse effect of immune checkpoint inhibition and is associated with a high rate of mortality.
METHODS
In this reported case, a 64-year-old woman with right temporo-parietal glioblastoma IDH-WT was treated with nivolumab, temozolomide and radiation therapy on a clinical trial. She developed malignant arrhythmias secondary to histologically confirmed severe immune-mediated myocarditis. She was treated with equine anti-thymocyte globulin (ATGAM) due to development of malignant arrhythmias refractory to high-dose corticosteroids.
RESULTS
This report describes the only case of immune-mediated myocarditis treated with ATGAM resulting in a favourable outcome.
CONCLUSIONS
Use of ATGAM should be considered in cases of steroid-refractory immune-mediated myocarditis and administered in close consultation with a cardiac transplant team experienced in the use of this agent.
背景
免疫介导性心肌炎是免疫检查点抑制的一种罕见不良反应，且与高死亡率相关。
方法
在本报告病例中，一名64岁的右颞顶叶异柠檬酸脱氢酶野生型胶质母细胞瘤女性患者在一项临床试验中接受了纳武单抗、替莫唑胺和放射治疗。她因组织学确诊的严重免疫介导性心肌炎继发恶性心律失常。由于高剂量皮质类固醇治疗难治的恶性心律失常的出现，她接受了马抗胸腺细胞球蛋白（ATGAM）治疗。
结果
本报告描述了唯一一例用ATGAM治疗免疫介导性心肌炎并取得良好结果的病例。
结论
对于类固醇难治性免疫介导性心肌炎病例，应考虑使用ATGAM，并在与有使用该药物经验的心脏移植团队密切协商后给药。
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