Sakakibara-Konishi Jun, Sato Mineyoshi, Sato Michiko Takimoto, Kasahara Kohei, Onozawa Masahiro, Mizugaki Hidenori, Kikuchi Eiki, Asahina Hajime, Shinagawa Naofumi, Konno Satoshi
First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan.
Department of Hematology, Hokkaido University Hospital, Sapporo, Japan.
Respir Med Case Rep. 2020 Jul 17;31:101170. doi: 10.1016/j.rmcr.2020.101170. eCollection 2020.
Malignant pleural mesothelioma (MPM) is a rare and highly aggressive tumor. Nivolumab showed durable antitumor effect in patients with recurrent MPM and was approved for those patients in Japan in 2018. Immune related adverse event (irAE) is occurred in various organs and is suggestive to be related to better outcome of nivolumab. Frequency of hematological irAE is low and there are few reports about hematological irAE and association between irAE and outcome of nivolumab in patients with MPM. We present a case of recurrent MPM who responded to nivolumab treatment and experienced nivolumab-induced immune thrombocytopenia (ITP). Although high dose dexamethasone was administered and platelet count increased transiently, re-administration of dexamethasone was required to maintain normal count of platelet. The careful and intensive management of ITP treatment is necessary in cases who show no response or relapse to initial glucocorticoids treatment. This is the first report about nivolumab-induced ITP and association with response to nivolumab in MPM.
恶性胸膜间皮瘤（MPM）是一种罕见且侵袭性很强的肿瘤。纳武单抗在复发性MPM患者中显示出持久的抗肿瘤作用，并于2018年在日本被批准用于这些患者。免疫相关不良事件（irAE）发生在各个器官，提示与纳武单抗更好的疗效相关。血液学irAE的发生率较低，关于MPM患者血液学irAE以及irAE与纳武单抗疗效之间关联的报道较少。我们报告一例复发性MPM患者，其对纳武单抗治疗有反应，并出现了纳武单抗诱导的免疫性血小板减少症（ITP）。尽管给予了高剂量地塞米松，血小板计数短暂升高，但仍需要再次给予地塞米松以维持血小板正常计数。对于初始糖皮质激素治疗无反应或复发的病例，需要对ITP治疗进行仔细和强化的管理。这是关于纳武单抗诱导的ITP以及与MPM中纳武单抗疗效关联的首例报告。
