Division of Hematology, Department of Medicine, Mayo Clinic, 200 First street Southwest, Rochester, Minnesota 55905, USA; Division of Medical Oncology, Department of Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA.
Division of Hematology, Department of Medicine, Mayo Clinic, 200 First street Southwest, Rochester, Minnesota 55905, USA; Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, Minnesota 55905, USA.
Hematol Oncol Clin North Am. 2022 Apr;36(2):365-380. doi: 10.1016/j.hoc.2021.11.002.
Over the past decade, the role of immunotherapy treatment in cancer has expanded; specifically, indications for immune checkpoint inhibitors (ICI) have multiplied and are used as first-line therapy. ICIs include cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 inhibitors, as monotherapies or in combination. Autoimmune hemolytic anemia (AIHA) has emerged as a rare yet serious immune-related adverse event in ICI use. This review describes diagnosis and management of immunotherapy related AIHA (ir-AIHA) including an algorithmic approach based on severity of anemia. Suggested mechanisms are discussed, guidance on ICI resumption provided and prognosis reviewed including risk of recurrence.
在过去的十年中，免疫疗法在癌症治疗中的作用不断扩大；具体来说，免疫检查点抑制剂（ICI）的适应证不断增加，并被用作一线治疗药物。ICI 包括细胞毒性 T 淋巴细胞相关蛋白 4 和程序性细胞死亡蛋白 1 抑制剂，可单独使用或联合使用。自身免疫性溶血性贫血（AIHA）已成为 ICI 使用中罕见但严重的免疫相关不良事件。本文综述了免疫治疗相关 AIHA（ir-AIHA）的诊断和治疗，包括基于贫血严重程度的算法方法。讨论了建议的发病机制，提供了 ICI 恢复的指导，并回顾了预后，包括复发风险。
