Kanno Ryota, Saito Yoshitaka, Takekuma Yoh, Asahina Hajime, Sugawara Mitsuru
Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Case Rep Oncol. 2023 May 24;16(1):372-377. doi: 10.1159/000530338. eCollection 2023 Jan-Dec.
Here, we describe a case of temporary severe neutropenia after atezolizumab monotherapy and its treatment course. Atezolizumab monotherapy was introduced as a 6th-line treatment for a man in his late 60s, who was diagnosed with stage Ⅳ lung adenocarcinoma. The first treatment cycle was administered during hospitalization, and the patient presented with a fever of 37.8°C on the first day. The fever resolved after the administration of acetaminophen and naproxen, and the white blood cell count, neutrophil count, and other white blood cell fractions were normal. However, grade 3 leukopenia and grade 4 neutropenia appeared at the beginning of the third cycle, and treatment was discontinued. After treatment, monocyte count in the leukocyte fraction increased from approximately 10% to 25.6%. Lenograstim 100 μg subcutaneous injection and oral levofloxacin 500 mg once daily were started of onset of neutropenia, and he was hospitalized the next day. Laboratory findings upon admission showed a significant improvement to 5,300/µL for leukocytes and 3,376/µL for neutrophils. Lenograstim was discontinued, with no further decrease in the neutrophil count. Atezolizumab therapy was resumed, and there was no further reduction in leukocyte, neutrophil, or leukocyte fractions over about a 2-year period. Concomitant drugs were maintained during the atezolizumab treatment, suggesting that they did not induce neutropenia. In conclusion, we observed temporary severe neutropenia during atezolizumab monotherapy. Neutrophil recovery with cautious monitoring has enabled longer efficacy. We should consider temporary symptom occurrence in cases of haematological immune-related adverse events.
在此，我们描述了一例阿替利珠单抗单药治疗后出现的暂时性严重中性粒细胞减少症及其治疗过程。阿替利珠单抗单药治疗被用作一名60多岁男性的第六线治疗方案，该患者被诊断为Ⅳ期肺腺癌。首个治疗周期在住院期间进行，患者在第一天出现37.8°C的发热。服用对乙酰氨基酚和萘普生后发热消退，白细胞计数、中性粒细胞计数及其他白细胞分类均正常。然而，在第三个周期开始时出现了3级白细胞减少和4级中性粒细胞减少，治疗中断。治疗后，白细胞分类中的单核细胞计数从约10%增至25.6%。中性粒细胞减少症发作时开始皮下注射100μg来格司亭并每日口服一次500mg左氧氟沙星，次日患者住院。入院时实验室检查结果显示白细胞显著改善至5300/µL，中性粒细胞为3376/µL。来格司亭停药，中性粒细胞计数未进一步下降。阿替利珠单抗治疗恢复，在约2年的时间里白细胞、中性粒细胞或白细胞分类均未进一步降低。阿替利珠单抗治疗期间维持使用伴随药物，提示它们未诱发中性粒细胞减少。总之，我们观察到阿替利珠单抗单药治疗期间出现暂时性严重中性粒细胞减少症。通过谨慎监测实现中性粒细胞恢复从而使疗效得以延长。对于血液学免疫相关不良事件，我们应考虑到暂时性症状的发生。
