Diamantopoulos Panagiotis T, Gkoufa Aikaterini, Anastasopoulou Amalia, Kouzis Panagiotis, Lyrarakis Georgios, Kyriakakis Georgios, Gogas Helen
First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Cancer Med. 2025 Apr;14(7):e70679. doi: 10.1002/cam4.70679.
Immune-related eosinophilia has emerged as an adverse event associated with immune checkpoint inhibitors (ICIs). Its prevalence, severity, duration, clinical significance, diagnostic approach, and management remain unexplored.
We conducted a retrospective review of melanoma patient records at a university referral center. Our analysis encompassed the incidence of eosinophilia, baseline disease characteristics, treatment modalities, peak eosinophil counts, associated symptoms, diagnostic procedures, management strategies, disease course, and prognostic implications.
A total of 308 patients were included. Eosinophilia was present in 21.4%, and there was no association with gender, age, histologic type, stage, or BRAF mutation status. The median time interval from treatment initiation to the eosinophilia onset was 56 days, the median eosinophil count at first presentation was 0.70 × 10/L, and the maximum eosinophil count was 1.02 × 10/L. The rate of eosinophilia was significantly higher in patients treated with nivolumab plus bempegaldesleukin (50.0%), followed by nivolumab plus ipilimumab (21.7%). Symptomatic patients and/or patients with hypereosinophilia were assessed for organ involvement and for the identification of the cause of eosinophilia. Patients requiring medical intervention were managed with corticosteroids or antihistamines. Eosinophilia relapsed in 31.8% when rechallenged. While non-significant, there was a numeric trend for longer overall survival in patients with eosinophilia (42.6 vs. 27.9 months, p = 0.178).
This study marks the first comprehensive approach of the relationship between the type of immunotherapy and the incidence of eosinophilia in melanoma patients. It also delves into the patients' baseline characteristics, diagnostic assessment, management, and prognosis, providing useful guidance for physicians treating patients with ICIs.
免疫相关嗜酸性粒细胞增多症已成为与免疫检查点抑制剂（ICI）相关的不良事件。其患病率、严重程度、持续时间、临床意义、诊断方法及管理仍未得到充分研究。
我们对一家大学转诊中心的黑色素瘤患者记录进行了回顾性分析。我们的分析涵盖了嗜酸性粒细胞增多症的发生率、基线疾病特征、治疗方式、嗜酸性粒细胞峰值计数、相关症状、诊断程序、管理策略、病程及预后影响。
共纳入308例患者。嗜酸性粒细胞增多症的发生率为21.4%，与性别、年龄、组织学类型、分期或BRAF突变状态无关。从开始治疗到嗜酸性粒细胞增多症发作的中位时间间隔为56天，首次出现时嗜酸性粒细胞计数的中位数为0.70×10⁹/L，最高嗜酸性粒细胞计数为1.02×10⁹/L。接受纳武利尤单抗加贝姆培拉达西布治疗的患者中嗜酸性粒细胞增多症的发生率显著更高（50.0%），其次是纳武利尤单抗加伊匹木单抗（21.7%）。对有症状的患者和/或嗜酸性粒细胞增多症患者进行器官受累情况评估及嗜酸性粒细胞增多症病因鉴定。需要药物干预的患者接受皮质类固醇或抗组胺药治疗。再次激发时，31.8%的患者嗜酸性粒细胞增多症复发。虽然无统计学意义，但嗜酸性粒细胞增多症患者的总生存期有延长的数值趋势（42.6个月对27.9个月，p = 0.178）。
本研究首次全面探讨了免疫治疗类型与黑色素瘤患者嗜酸性粒细胞增多症发生率之间的关系。它还深入研究了患者的基线特征、诊断评估、管理及预后，为治疗ICI患者的医生提供了有用的指导。
