Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Neurology, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan.
J Neurol. 2021 Feb;268(2):680-688. doi: 10.1007/s00415-020-10213-x. Epub 2020 Sep 9.
The purpose of the present study is to report the clinical characteristics of polyradiculoneuropathy induced by immune checkpoint inhibitors (ICIs).
We retrospectively reviewed lists of all inpatients with neurological immune-related adverse events (irAEs) treated at the neurology departments of three hospitals in January 2017 and December 2019. We also performed a review of the previous case reports with polyradiculoneuropathy induced by ICI therapy.
We had 4 patients with polyradiculoneuropathy following ICI therapy. We comprehensively reviewed our 4 patients and 32 previous case reports. There were 28 men and 8 women with a mean onset age of 61 years. ICI monotherapy was performed in 27 patients, whereas the combination of ICIs was administered in 9 patients. All patients except 2 showed limb weakness, which was observed symmetrically and predominantly in the legs rather than the arms. Bulbar involvement was observed in 7 patients. The laboratory findings were demyelination in electrophysiological studies and elevated protein with lymphocytes in the cerebrospinal fluid. Disease severity was ranked on the Hughes functional scale; 17 patients were grade 4 or greater. The treatment responses to corticosteroid and intravenous methylprednisolone were favorable. Intravenous immunoglobulin was also used in combination with steroids. Seven patients died, including 4 who on mechanical ventilation.
Polyradiculoneuropathy induced by ICIs has a distinct subset of neurological irAEs and requires early recognition.
本研究旨在报告免疫检查点抑制剂（ICIs）引起的多神经根神经病的临床特征。
我们回顾性地审查了 2017 年 1 月至 2019 年 12 月在三家医院神经科治疗的所有患有神经免疫相关不良事件（irAE）的住院患者名单，并对先前报道的与 ICI 治疗相关的多神经根神经病病例进行了回顾。
我们有 4 例接受 ICI 治疗后发生多神经根神经病的患者。我们全面回顾了我们的 4 例患者和 32 例先前的病例报告。28 例为男性，8 例为女性，平均发病年龄为 61 岁。27 例患者接受了 ICI 单药治疗，9 例患者接受了 ICI 联合治疗。除 2 例患者外，所有患者均表现为肢体无力，表现为对称性和下肢为主，上肢受累较轻。7 例患者存在球部受累。电生理研究显示脱髓鞘改变，脑脊液蛋白升高伴淋巴细胞增多。疾病严重程度按 Hughes 功能量表分级；17 例患者为 4 级或更高级别。皮质类固醇和静脉甲基强的松龙治疗反应良好，也联合使用静脉注射免疫球蛋白。7 例患者死亡，其中 4 例患者需要机械通气。
ICI 引起的多神经根神经病是一组具有独特特征的神经免疫相关不良事件，需要早期识别。
