Tiu Crescens, Shinde Rajiv, Pal Abhijit, Biondo Andrea, Lee Alex, Tunariu Nina, Jhanji Shaman, Grover Vimal, Tatham Kate, Gruber Pascale, Banerji Udai, De Bono Johann S, Nicholson Emma, Minchom Anna R, Lopez Juanita S
Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom.
Critical Care Unit, The Royal Marsden Hospital, Sutton, United Kingdom.
J Immunother Precis Oncol. 2021 Sep 7;4(4):189-195. doi: 10.36401/JIPO-21-9. eCollection 2021 Nov.
Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH).
All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection.
Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH.
SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.
免疫检查点抑制剂（ICIs）越来越多地成为许多癌症的治疗标准；这些药物可导致免疫相关不良事件（irAEs），包括发热，发热很常见，但很少与全身免疫激活（SIA或获得性噬血细胞性淋巴组织细胞增生症[HLH]）相关。
对2014年5月至2019年11月在皇家马斯登医院药物研发部门接受ICIs治疗的所有连续患者进行回顾性研究。确定开始使用ICIs后6周内出现发热≥38°C或寒战/畏寒（无发热）的患者以收集临床数据。
3例患者符合SIA/HLH的诊断标准，症状出现的中位时间为10天。我们描述了这些患者的临床病程、所用治疗方法及转归。高剂量类固醇作为一线治疗药物，对于类固醇难治性SIA/HLH，可考虑使用其他治疗方法，如托珠单抗、免疫球蛋白和治疗性血浆置换。
ICI治疗后发生的SIA/HLH是一种罕见但可能致命的irAE，表现为发热和一系列非特异性症状。早期识别和及时治疗是改善转归的关键。
