Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Department of Hematology and Oncology, Osaka University Graduate School of Medicine, 2-2-C9, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
Int J Hematol. 2022 Aug;116(2):302-306. doi: 10.1007/s12185-022-03312-0. Epub 2022 Feb 24.
Nivolumab is an anti-programmed cell death protein 1 monoclonal antibody that exhibits significant efficacy in treating melanoma and other malignancies. However, various nivolumab-induced immune-related adverse events (irAEs) have been reported, and differentiating irAEs from tumor progression is sometimes difficult. Here, we report a case of reactive lymphadenopathy occurring after treatment with nivolumab. A 56-year-old man with stage IIIC melanoma received adjuvant therapy with nivolumab after wide local excision. He developed systemic lymphadenopathy and autoimmune hemolytic anemia 1 month after receiving seven cycles of nivolumab. Pathological analysis of a cervical lymph node biopsy specimen revealed no metastatic lesion or any other malignancy, including lymphoma. Thus, the patient was diagnosed with nivolumab-induced reactive lymphadenopathy. Systemic corticosteroids were administered to reduce hemolysis, which led to the resolution of lymphadenopathy. When progressive lymphadenopathy is observed in a patient who received immune checkpoint inhibitor therapy, reactive lymphadenopathy should be carefully distinguished from progression to lymphoid metastasis, and biopsy should be performed if needed.
纳武利尤单抗是一种抗程序性死亡蛋白 1 的单克隆抗体，在治疗黑色素瘤和其他恶性肿瘤方面显示出显著的疗效。然而，已经报道了各种纳武利尤单抗诱导的免疫相关不良反应（irAEs），并且有时很难将 irAEs 与肿瘤进展区分开来。在这里，我们报告了一例纳武利尤单抗治疗后发生的反应性淋巴结病。一名 56 岁男性患有 IIIC 期黑色素瘤，在广泛局部切除后接受纳武利尤单抗辅助治疗。他在接受 7 个周期的纳武利尤单抗治疗后 1 个月出现全身淋巴结病和自身免疫性溶血性贫血。颈淋巴结活检标本的病理分析显示无转移性病变或任何其他恶性肿瘤，包括淋巴瘤。因此，该患者被诊断为纳武利尤单抗诱导的反应性淋巴结病。给予全身皮质类固醇以减少溶血，导致淋巴结病缓解。当接受免疫检查点抑制剂治疗的患者出现进行性淋巴结病时，应仔细区分反应性淋巴结病与向淋巴转移的进展，如果需要，应进行活检。
