免疫检查点抑制剂治疗肺腺癌患者出现纯红细胞再生障碍和染色体异常：病例报告。
Pure Red Cell Aplasia and Chromosomal Abnormality in a Patient With Lung Adenocarcinoma Receiving Immune Checkpoint Inhibitors: A Case Report.
机构信息
First Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
First Department of Internal Medicine, Toyama University Hospital, Toyama, Japan;
出版信息
In Vivo. 2024 May-Jun;38(3):1509-1511. doi: 10.21873/invivo.13599.
BACKGROUND/AIM: Immune checkpoint inhibitors can induce immune-related adverse events in various organs, thus careful observation is required.
CASE REPORT
A 69-year-old man was diagnosed with advanced lung adenocarcinoma and treated with combined therapy of carboplatin plus pemetrexed plus pembrolizumab. After two cycles of treatment, anemia was noted. Myelosuppression due to cytotoxic anticancer agents was suspected and the cytotoxic agents were discontinued, followed by three courses of pembrolizumab monotherapy. However, the anemia persisted, requiring red blood cell transfusions. A bone marrow biopsy revealed erythroblast hypoplasia and chromosomal abnormalities, resulting in a diagnosis of pure red cell aplasia. These adverse events were considered immune-related because of the treatment history with an immune checkpoint inhibitor, and 60 mg/day (1 mg/kg/day) of prednisolone was initiated. Anemia improved, and it did not recur during the tapering of prednisolone.
CONCLUSION
Immune-related pure red cell aplasia should be considered for patients presenting anemia during treatment with immune checkpoint inhibitors.
背景/目的：免疫检查点抑制剂可在各种器官引发免疫相关不良反应，因此需要仔细观察。
病例报告
一名 69 岁男性被诊断为晚期肺腺癌，并接受卡铂加培美曲塞加帕博利珠单抗联合治疗。治疗两个周期后，出现贫血。怀疑是细胞毒性抗癌药物引起的骨髓抑制，停用细胞毒性药物，并随后进行了三程帕博利珠单抗单药治疗。然而，贫血仍持续存在，需要输血。骨髓活检显示成红细胞发育不良和染色体异常，诊断为纯红细胞再生障碍。由于有免疫检查点抑制剂治疗史，这些不良反应被认为是免疫相关的，因此开始使用 60 毫克/天（1 毫克/千克/天）的泼尼松龙。贫血得到改善，并且在泼尼松龙减量过程中未再复发。
结论
对于接受免疫检查点抑制剂治疗期间出现贫血的患者，应考虑免疫相关的纯红细胞再生障碍。
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