Qin Yanzhu, Lu Shuaiji, Chen Jingwen, Peng Jing, Yang Jijun
Department of Pulmonary and Critical Care Medicine-Section 5, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Intensive Care Medicine, Affiliated Loudi Hospital, Hengyang Medical School, University of South China, Loudi, Hunan, China.
Front Oncol. 2024 Jun 18;14:1415748. doi: 10.3389/fonc.2024.1415748. eCollection 2024.
Immune checkpoint inhibitors (ICIs) demonstrate unique advantages in the treatment of lung cancer and are widely used in the era of immunotherapy. However, ICIs can cause adverse reactions. Hematological toxicities induced by immunotherapy are relatively rare. Agranulocytosis, a rare hematologic adverse event associated with immune checkpoint inhibitors, has received limited attention in terms of treatment and patient demographics. Herein, we report the case of a 68-year-old male with non-small cell lung cancer(NSCLC) who received two cycles of programmed cell death-1 (PD-1) antibody sintilimab immunotherapy combined with albumin-bound paclitaxel and carboplatin chemotherapy and one cycle of sintilimab monotherapy. He was diagnosed with grade 4 neutropenia and sepsis (with symptoms of fever and chills) after the first two cycles of treatment. Teicoplanin was promptly initiated as antimicrobial therapy. The patient presented with sudden high fever and developed agranulocytosis on the day of the third cycle of treatment initiation, characterized by an absolute neutrophil count of 0.0×10/L. The patient was treated with granulocyte colony-stimulating factor but did not show improvement. He was then treated with corticosteroids, and absolute neutrophil counts gradually returned to normal levels. To the best of our knowledge, this is the first reported case of sintilimab-induced agranulocytosis in a patient with NSCLC. Sintilimab-induced severe neutropenia or agranulocytosis is a rare side effect that should be distinguished from chemotherapy-induced neutropenia and treated promptly with appropriate therapies; otherwise, the condition may worsen.
免疫检查点抑制剂（ICIs）在肺癌治疗中显示出独特优势，在免疫治疗时代被广泛应用。然而，ICIs可引起不良反应。免疫治疗引起的血液学毒性相对少见。粒细胞缺乏症是一种与免疫检查点抑制剂相关的罕见血液学不良事件，在治疗和患者人口统计学方面受到的关注有限。在此，我们报告一例68岁非小细胞肺癌（NSCLC）男性患者的病例，该患者接受了两个周期的程序性细胞死亡蛋白1（PD-1）抗体信迪利单抗免疫治疗联合白蛋白结合型紫杉醇和卡铂化疗，以及一个周期的信迪利单抗单药治疗。在前两个周期治疗后，他被诊断为4级中性粒细胞减少症和脓毒症（伴有发热和寒战症状）。立即开始使用替考拉宁进行抗菌治疗。在开始第三个周期治疗当天，患者突然高热并出现粒细胞缺乏症，其特征为绝对中性粒细胞计数为0.0×10⁹/L。患者接受了粒细胞集落刺激因子治疗，但未见改善。随后给予糖皮质激素治疗，绝对中性粒细胞计数逐渐恢复至正常水平。据我们所知，这是首例报道的信迪利单抗诱导NSCLC患者发生粒细胞缺乏症的病例。信迪利单抗诱导的严重中性粒细胞减少症或粒细胞缺乏症是一种罕见的副作用，应与化疗诱导的中性粒细胞减少症相鉴别，并及时采用适当疗法进行治疗；否则，病情可能会恶化。
