El-Ghazzi Nathan, Monier Anna, Italiano Antoine, Besson Aude, Angeli Eurydice
Medical Oncology Department, Institut Bergonié, Bordeaux, France.
Internal Medicine Department, Bordeaux University Hospital, Hôpital Pellegrin, University of Bordeaux, Bordeaux, France.
Platelets. 2025 Dec;36(1):2487767. doi: 10.1080/09537104.2025.2487767. Epub 2025 Apr 3.
Immune-checkpoint blockades (ICBs) are now used in early-stage diseases like triple-negative breast cancer (TNBC). While effective, they can cause severe toxicities. We report the first case of life-threatening immune thrombocytopenia (ITP) induced by pembrolizumab during neoadjuvant chemo-immunotherapy for early TNBC. A 42-year-old woman with early-stage TNBC developed grade 4 thrombocytopenia, diagnosed as ITP, after 107 days of pembrolizumab treatment. She required intensive care unit (ICU) admission and high-dose steroids, and intravenous immunoglobulin therapy, leading to a rapid recovery. ITP is a rare but potentially fatal complication of immunotherapy, with an incidence of less than 1% and a mortality rate of up to 20% in affected patients. Immediate recognition and steroid therapy are critical, as platelet transfusion is usually ineffective. Diagnosis is often delayed due to its similarity to chemotherapy-induced marrow toxicity. Immunotherapy-induced ITP generally contraindicates further use of the treatment. ITP, although uncommon, is a serious complication of immunotherapy requiring immediate intervention. The growing use of immunotherapy necessitates increased awareness of its potential toxicities among healthcare providers.
免疫检查点阻断疗法（ICBs）目前用于三阴性乳腺癌（TNBC）等早期疾病。虽然有效，但它们可能会导致严重的毒性反应。我们报告了首例在早期TNBC新辅助化疗免疫治疗期间由帕博利珠单抗诱发的危及生命的免疫性血小板减少症（ITP）。一名患有早期TNBC的42岁女性在接受帕博利珠单抗治疗107天后出现4级血小板减少症，被诊断为ITP。她需要入住重症监护病房（ICU）并接受大剂量类固醇以及静脉注射免疫球蛋白治疗，从而实现了快速康复。ITP是免疫治疗一种罕见但可能致命的并发症，在受影响的患者中发病率低于1%，死亡率高达20%。立即识别并进行类固醇治疗至关重要，因为血小板输注通常无效。由于其与化疗引起的骨髓毒性相似，诊断往往会延迟。免疫治疗诱发的ITP通常禁忌进一步使用该治疗方法。ITP虽然不常见，但却是免疫治疗的一种严重并发症，需要立即进行干预。免疫治疗的使用日益增加，这就需要医疗服务提供者提高对其潜在毒性的认识。
