Department of Neurology, Stanford University School of Medicine, Stanford, CA.
Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
J Clin Neuromuscul Dis. 2023 Dec 1;25(2):89-93. doi: 10.1097/CND.0000000000000457. Epub 2023 Nov 13.
Immune checkpoint inhibitors used to treat malignancies may lead to various immune-related adverse events (irAEs) including conditions such as myositis and myasthenia gravis (MG). Here, we describe 2 cases of myositis treated effectively with therapeutic plasma exchange (PLEX). A 64-year-old man with thymic cancer developed leg weakness and dyspnea 1 month after the second dose of nivolumab with moderate weakness in proximal and distal muscles, with elevated creatine kinase levels. Another 77-year-old man with Stage IIIB squamous cell carcinoma of the lung developed progressive proximal muscle weakness and became nonambulatory after cycle 2 of durvalumab with persistently high creatine kinase levels despite prednisone treatment. Electrophysiology revealed irritative myopathy without evidence of neuromuscular junction dysfunction and MG antibody testing was nonrevealing. With PLEX, both patients noticed rapid improvement in strength. PLEX in conjunction with other immunosuppressive agents can result in rapid improvement in irAE-myositis even in patients without associated MG.
用于治疗恶性肿瘤的免疫检查点抑制剂可能导致各种免疫相关不良事件（irAEs），包括肌炎和重症肌无力（MG）等疾病。在这里，我们描述了 2 例用治疗性血浆置换（PLEX）有效治疗的肌炎病例。一名 64 岁男性患有胸腺癌，在接受第二剂纳武单抗后 1 个月出现腿部无力和呼吸困难，近端和远端肌肉中度无力，肌酸激酶水平升高。另一名 77 岁男性患有 IIIB 期肺鳞状细胞癌，在接受第 2 周期度伐单抗治疗后出现进行性近端肌无力，无法行走，尽管泼尼松治疗，但肌酸激酶水平持续升高。电生理学显示肌病有刺激性而无神经肌肉接头功能障碍的证据，MG 抗体检测无异常。接受 PLEX 治疗后，两名患者均注意到肌力迅速改善。PLEX 联合其他免疫抑制剂可导致 irAE-肌炎迅速改善，即使在无相关 MG 的患者中也是如此。
