Jalil Ahmad, Zaffar Javariya, Waqas Aimal, Butt Shayan
Internal Medicine, King Edward Medical University, Lahore, PAK.
Internal Medicine, Rehman Medical College, Peshawar, PAK.
Cureus. 2023 Sep 21;15(9):e45674. doi: 10.7759/cureus.45674. eCollection 2023 Sep.
In this article, we explore the correlation between immune checkpoint inhibitors (ICIs) and neutropenia. Immune checkpoint inhibitors have revolutionized cancer treatment and management by maximizing the innate abilities of the immune system. However, this therapeutic potential is accompanied by a range of immune-related adverse effects (irAEs), including neutropenia, which is a rare but potentially life-threatening side effect of this mode of cancer treatment. Through an in-depth analysis of various case reports, we have compiled a detailed table summarizing the occurrences of neutropenia associated with different ICIs, the grades of neutropenia, treatments used, and patient outcomes. Management of neutropenia must include an approach based on early diagnosis of the condition and a treatment based on its severity. This review discusses different therapeutic interventions, ranging from the administration of corticosteroids and intravenous immunoglobulin (IVIG) to the use of granulocyte colony-stimulating factor (filgrastim) and, in very severe cases, a stem cell transplant. We have also enlisted salient side effects caused by these interventions. Our findings emphasize that while neutropenia is a relatively rare adverse effect of ICIs, its severity necessitates increased awareness among healthcare professionals. As ICIs continue to be seen as an integral component of cancer therapy, a comprehensive understanding of neutropenia as a side effect and its management is critical for optimizing patient outcomes. A crucial purpose of this review is to highlight the need to achieve a balance between acquiring the therapeutic benefits of various treatment strategies for irAEs and considering their potential side effects, especially with the use of steroids. Achieving this equilibrium is very important in optimizing patient care during immunotherapy, as these irAE management options can both mitigate the neutropenia triggered by ICIs and potentially give rise to secondary complications. Therefore, a careful assessment of the risks and benefits associated with each treatment approach is essential in tailoring irAE management.
在本文中，我们探讨免疫检查点抑制剂（ICI）与中性粒细胞减少症之间的关联。免疫检查点抑制剂通过最大限度地发挥免疫系统的固有能力，给癌症治疗和管理带来了变革。然而，这种治疗潜力伴随着一系列免疫相关不良反应（irAE），包括中性粒细胞减少症，这是这种癌症治疗方式罕见但可能危及生命的副作用。通过对各种病例报告的深入分析，我们编制了一份详细表格，总结了与不同ICI相关的中性粒细胞减少症的发生情况、中性粒细胞减少症的分级、所采用的治疗方法以及患者的结局。中性粒细胞减少症的管理必须包括基于病情早期诊断的方法和基于其严重程度的治疗。本综述讨论了不同的治疗干预措施，从使用皮质类固醇和静脉注射免疫球蛋白（IVIG）到使用粒细胞集落刺激因子（非格司亭），在非常严重的情况下，还包括干细胞移植。我们还列举了这些干预措施引起的显著副作用。我们的研究结果强调，虽然中性粒细胞减少症是ICI相对罕见的不良反应，但其严重性需要医护人员提高认识。随着ICI继续被视为癌症治疗的一个组成部分，全面了解中性粒细胞减少症作为一种副作用及其管理对于优化患者结局至关重要。本综述的一个关键目的是强调在获取各种治疗策略对irAE的治疗益处与考虑其潜在副作用之间取得平衡的必要性，尤其是在使用类固醇时。在免疫治疗期间优化患者护理方面，实现这种平衡非常重要，因为这些irAE管理选项既能减轻ICI引发的中性粒细胞减少症，又可能引发继发性并发症。因此，在定制irAE管理方案时，仔细评估每种治疗方法相关的风险和益处至关重要。
