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一名晚期肺腺癌和慢性淋巴细胞白血病患者在接受纳武单抗和静脉注射免疫球蛋白治疗时发生自身免疫性溶血性贫血。

Autoimmune haemolytic anaemia in a patient with advanced lung adenocarcinoma and chronic lymphocytic leukaemia receiving nivolumab and intravenous immunoglobulin.

作者信息

Algaze Sandra D, Park Wungki, Harrington Thomas J, Mudad Raja

机构信息

Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.

Department of Internal Medicine, University of Miami Health System, Miami, Florida, USA.

出版信息

BMJ Case Rep. 2018 Mar 9;2018:bcr-2017-221801. doi: 10.1136/bcr-2017-221801.

Abstract

We describe a rare case of severe autoimmune haemolytic anaemia (AIHA) in the setting of underlying chronic lymphocytic leukaemia receiving intravenous immunoglobulin, history of warm IgG autoantibody and treatment with nivolumab for advanced non-small cell lung cancer. In this report, we describe AIHA as a potential serious immune-related adverse event from immune checkpoint inhibitors, discuss other potential contributing factors and review previously described cases of AIHA in patients receiving programmed death 1 (PD-1) inhibitors. In the era of immunotherapy, we hope to add literature to raise awareness of potential immune-related sequelae such as AIHA. We aim to highlight the importance of close monitoring for prompt identification and management of potentially fatal AIHA and immune-related adverse events of PD-1 inhibitors by holding immunotherapy and treating with high-dose steroids, particularly in subgroups which may be at increased risk.

摘要

我们描述了一例罕见的严重自身免疫性溶血性贫血(AIHA)病例,该患者患有慢性淋巴细胞白血病,正在接受静脉注射免疫球蛋白治疗,有温抗体型IgG自身抗体病史,且因晚期非小细胞肺癌接受纳武单抗治疗。在本报告中,我们将AIHA描述为免疫检查点抑制剂可能引发的严重免疫相关不良事件,讨论其他潜在促成因素,并回顾先前报道的接受程序性死亡1(PD-1)抑制剂治疗的患者发生AIHA的病例。在免疫治疗时代,我们希望补充文献资料,以提高对诸如AIHA等潜在免疫相关后遗症的认识。我们旨在强调密切监测的重要性,以便通过暂停免疫治疗并给予大剂量类固醇治疗,及时识别和管理潜在致命的AIHA及PD-1抑制剂的免疫相关不良事件,特别是在可能风险增加的亚组中。

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