Wilson Robert, Menassa David A, Davies Alexander J, Michael Sophia, Hester Joanna, Kuker Wilhelm, Collins Graham P, Cossins Judith, Beeson David, Steven Neil, Maddison Paul, Rinaldi Simon, Jacob Saiju, Irani Sarosh R
Oxford Autoimmune Neurology Group Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom.
Nuffield Department of Surgical Sciences University of Oxford John Radcliffe Hospital Oxford United Kingdom.
Ann Clin Transl Neurol. 2018 Mar 25;5(5):640-645. doi: 10.1002/acn3.547. eCollection 2018 May.
Checkpoint inhibitor medications have revolutionized oncology practice, but frequently induce immune-related adverse events. During autoimmune neurology practice over 20 months, we prospectively identified four patients with likely antibody-mediated neurological diseases after checkpoint inhibitors: longitudinally extensive transverse myelitis, Guillain-Barré syndrome, and myasthenia gravis. All patients shared three characteristics: symptoms commenced 4 weeks after drug administration, responses to conventional immunotherapies were excellent, and autoantibodies traditionally associated with their syndrome were absent. However, serum immunoglobulins from the myelitis and Guillain-Barré syndrome patients showed novel patterns of tissue reactivity. Vigilance is required for antibody-mediated neurology after checkpoint inhibitor administration. This phenomenon may inform the immunobiology of antibody-mediated diseases.
检查点抑制剂药物彻底改变了肿瘤学治疗方法，但经常会引发免疫相关不良事件。在超过20个月的自身免疫性神经病学临床实践中，我们前瞻性地确定了4例在使用检查点抑制剂后可能患有抗体介导的神经系统疾病的患者：纵向广泛横贯性脊髓炎、吉兰-巴雷综合征和重症肌无力。所有患者都有三个共同特征：症状在给药后4周开始出现，对传统免疫疗法反应良好，且不存在传统上与其综合征相关的自身抗体。然而，脊髓炎和吉兰-巴雷综合征患者的血清免疫球蛋白显示出新型的组织反应模式。使用检查点抑制剂后，对于抗体介导的神经病学需要保持警惕。这一现象可能为抗体介导疾病的免疫生物学提供信息。
