Tan Qiaoyun, Liu Lichao, Huang Yu, Dong Xiaorong, Chen Lingjuan
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Nov 25;12:973421. doi: 10.3389/fonc.2022.973421. eCollection 2022.
Immune checkpoint inhibitors, including anti-PD-1 therapies, have prolonged overall survival in patients with a variety of cancers, and immunotherapy is sometimes associated with immune-related adverse events (irAEs); however, hematological toxicity, especially neutropenia, is rare.
A 78-year-old man with squamous lung cancer, with brain metastasis, was treated with pembrolizumab and albumin-bound paclitaxel as first-line treatment for one cycle and changed to pembrolizumab plus anlotinib at the second cycle. After two therapy cycles, grade 4 neutropenia developed, which mainly contributed to irAEs. The patient was started on granulocyte colony-stimulating factor (G-CSF) but did not improve; he was then treated with corticosteroids, and neutrophil counts gradually returned to normal levels. However, the patient eventually died because of neurological problems.
Grade 4 neutropenia associated with ICI, although rare, is often severe and presents with infectious complications; it needs to be diagnosed early, and clinicians should ensure prompt and proper management to such patients.
免疫检查点抑制剂，包括抗程序性死亡蛋白1（PD-1）疗法，已延长了多种癌症患者的总生存期，且免疫疗法有时会伴有免疫相关不良事件（irAE）；然而，血液学毒性，尤其是中性粒细胞减少症较为罕见。
一名78岁的鳞状肺癌伴脑转移男性患者，一线接受帕博利珠单抗和白蛋白结合型紫杉醇治疗一个周期，第二个周期改为帕博利珠单抗加安罗替尼治疗。两个治疗周期后，出现4级中性粒细胞减少症，这主要导致了免疫相关不良事件。患者开始使用粒细胞集落刺激因子（G-CSF）治疗，但病情未改善；随后接受皮质类固醇治疗，中性粒细胞计数逐渐恢复至正常水平。然而，患者最终因神经系统问题死亡。
与免疫检查点抑制剂相关的4级中性粒细胞减少症虽然罕见，但通常较为严重，并伴有感染性并发症；需要早期诊断，临床医生应确保对此类患者进行及时、恰当的管理。
