免疫检查点相关噬血细胞性淋巴组织细胞增生症一例报告及文献复习
A Case Report of Immune Checkpoint-Related Hemophagocytic Lymphohistiocytosis and Review of the Literature.
作者信息
Herman Michael, Lee Andrea, Fawcett Sandra, Deodhare Sanjeev
机构信息
Department of Oncology, Halton Healthcare, Oakville, ON, Canada.
Department of Pathology, Halton Healthcare, Oakville, ON, Canada.
出版信息
Case Rep Oncol. 2024 Jul 30;17(1):809-817. doi: 10.1159/000539955. eCollection 2024 Jan-Dec.
INTRODUCTION
Hemophagocytic lymphohistiocytosis (HLH) secondary to immune checkpoint inhibitors (irHLH) is rare, and consequently optimal management strategies remain to be defined. There are sparse reports of the successful treatment of irHLH with steroids and tocilizumab. This case adds to the body of literature supporting this management strategy.
CASE DESCRIPTION
We present a case of a patient with thoracic malignancy who received dual checkpoint inhibitors and developed weakness, fever, confusion, and cytopenias. Further testing revealed an extremely elevated ferritin level. Cytokine levels as well as HLH-2004 criteria and HScore results were consistent with irHLH. Clinical parameters and symptoms promptly improved after the administration of corticosteroids and tocilizumab.
CONCLUSION
This case highlights an important treatment strategy for an immune checkpoint inhibitor toxicity associated with a high mortality rate.
引言
免疫检查点抑制剂继发的噬血细胞性淋巴组织细胞增生症（irHLH）较为罕见，因此最佳管理策略仍有待确定。关于使用类固醇和托珠单抗成功治疗irHLH的报道较少。本病例补充了支持该管理策略的文献。
病例描述
我们报告一例患有胸段恶性肿瘤的患者，该患者接受了双重检查点抑制剂治疗，并出现了虚弱、发热、意识模糊和血细胞减少。进一步检查发现铁蛋白水平极度升高。细胞因子水平以及HLH-2004标准和HScore结果与irHLH一致。给予皮质类固醇和托珠单抗后，临床参数和症状迅速改善。
结论
本病例突出了一种针对与高死亡率相关的免疫检查点抑制剂毒性的重要治疗策略。
Zotero 插件