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病例报告:吗替麦考酚酯治疗免疫检查点抑制剂所致吉兰-巴雷综合征。

Case Report: ICIs-induced Guillain-Barré syndrome recovered from mycophenolate mofetil.

机构信息

Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.

Department of Biomedical Education and Data Sciences, Temple University School of Medicine, Philadelphia, PA, United States.

出版信息

Front Immunol. 2023 May 8;14:1132692. doi: 10.3389/fimmu.2023.1132692. eCollection 2023.

Abstract

The emergence of immune checkpoint inhibitors (ICIs) has significantly prolonged the survival time of cancer patients. However, it may also lead to various immune-related adverse events (irAEs), including Guillain-Barré syndrome (GBS), a rare type of irAE. Most GBS patients can recover spontaneously due to the self-limited nature of the disease, but severe cases can result in respiratory failure or even death. Here we report a rare case of GBS occurring in a 58-year-old male patient with non-small cell lung cancer (NSCLC) who developed muscle weakness and numbness of the extremities during chemotherapy combined with KN046, a PD-L1/CTLA-4 bispecific antibody. Despite receiving methylprednisolone and γ-globulin, the patient's symptoms did not improve. However, there was significant improvement after treatment with mycophenolate mofetil (MM) capsules, which is not a routine regimen for GBS. To the best of our knowledge, this is the first reported case of ICIs-induced GBS that responded well to mycophenolate mofetil instead of methylprednisolone or γ-globulin. Thus, it provides a new treatment option for patients with ICIs-induced GBS.

摘要

免疫检查点抑制剂 (ICIs) 的出现显著延长了癌症患者的生存时间。然而,它也可能导致各种免疫相关不良反应 (irAEs),包括吉兰-巴雷综合征 (GBS),这是一种罕见的 irAE。大多数 GBS 患者由于疾病的自限性可以自行恢复,但严重的病例可能导致呼吸衰竭甚至死亡。我们在此报告一例罕见的 GBS 病例,发生在一名 58 岁男性非小细胞肺癌 (NSCLC) 患者中,该患者在接受 PD-L1/CTLA-4 双特异性抗体 KN046 联合化疗期间出现四肢肌无力和麻木。尽管接受了甲基强的松龙和丙种球蛋白治疗,但患者的症状并未改善。然而,在用吗替麦考酚酯 (MM) 胶囊治疗后,症状有了显著改善,而 MM 胶囊并不是 GBS 的常规治疗方案。据我们所知,这是首例报道的对 ICI 诱导的 GBS 反应良好的吗替麦考酚酯而不是甲基强的松龙或丙种球蛋白的病例。因此,它为 ICI 诱导的 GBS 患者提供了一种新的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd2/10200921/edb315d90342/fimmu-14-1132692-g001.jpg

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