Isoda Atsushi, Miyazawa Yuri, Tahara Kenichi, Mihara Masahiro, Saito Akio, Matsumoto Morio, Sawamura Morio
Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan.
Department of Hematology, Hoshi Clinic, Japan.
Intern Med. 2020 Aug 15;59(16):2041-2045. doi: 10.2169/internalmedicine.4467-20. Epub 2020 May 8.
We herein report a 64-year-old man who was treated with pembrolizumab for relapsed Hodgkin lymphoma. After the third administration of pembrolizumab, he showed acute anemia with a positive direct anti-globulin test. Because of the markedly erythroid hypoplasia, he was diagnosed with pure red cell aplasia (PRCA) caused by pembrolizumab. He was initially treated with prednisolone, but the reticulocytes decreased after tapering prednisolone. He then received high-dose intravenous immunoglobulin (IVIG) with prednisolone, and PRCA was successfully treated. Although the pathogenesis of PRCA caused by immune checkpoint inhibitors (CPIs) remains unclear, IVIG treatment may be effective for some steroid-refractory CPI-induced PRCA cases.
我们在此报告一名64岁男性，其因复发性霍奇金淋巴瘤接受帕博利珠单抗治疗。在第三次使用帕博利珠单抗后，他出现急性贫血，直接抗球蛋白试验呈阳性。由于明显的红系造血低下，他被诊断为帕博利珠单抗所致的纯红细胞再生障碍性贫血（PRCA）。他最初接受泼尼松龙治疗，但在泼尼松龙减量后网织红细胞减少。随后他接受了大剂量静脉注射免疫球蛋白（IVIG）联合泼尼松龙治疗，PRCA得到成功治疗。尽管免疫检查点抑制剂（CPI）所致PRCA的发病机制尚不清楚，但IVIG治疗可能对一些类固醇难治性CPI诱导的PRCA病例有效。
