Gao Qian, Yao Zhaonong, Yao Yuhong, Liu Yunxia, Mao Jianshui, Li Binghao
Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Oncol. 2025 May 27;15:1574379. doi: 10.3389/fonc.2025.1574379. eCollection 2025.
Thrombocytopenia (TP) is a rare adverse event (<1%) associated with immune checkpoint inhibitor (ICI) therapy, termed immunotherapy-related thrombocytopenia (irTP). This condition is particularly concerning in patients with metastatic bone cancer due to the increased risk of life-threatening bleeding complications, which may further compromise patient management. Moreover, the scarcity of systematic reports on irTP in this population underscores the need for focused investigation.
We retrospectively reviewed the clinical records of patients with metastatic bone cancer who received single-agent ICI therapy-specifically, PD-1 inhibitors such as pembrolizumab, penpulimab, and sintilimab-between May 2020 and December 2024 at three tertiary hospitals. Patients who developed severe irTP were included in the analysis.
A total of 94 cases were screened, of which 7 patients (7.45%) were diagnosed with severe irTP. The primary cancer subtypes included melanoma (n = 4), undifferentiated pleomorphic sarcoma (n = 2), and renal clear cell carcinoma (n = 1). All seven patients were undergoing combination therapy with the bone anti-resorptive agent denosumab. The median time to irTP onset was 92 days after the initial ICI administration. Following diagnosis, all patients were hospitalized and received intensive immunomodulatory therapy, supportive care, and meticulous nursing management. While symptoms significantly improved in all cases, long-term follow-up indicated that patients remained stable after discharge. The median duration of hospitalization was 18 days.
Although irTP is considered rare in the literature, we observed an incidence of 7.45% in our cohort, highlighting a significant clinical concern due to the potential for severe bleeding complications in metastatic bone cancer patients. Timely diagnosis and comprehensive treatment-supported by interdisciplinary collaboration among oncologists, hematologists, and nursing staff-are essential for achieving full recovery. Furthermore, our findings emphasize the need for future research into predictive biomarkers and risk factors for irTP.
血小板减少症（TP）是一种与免疫检查点抑制剂（ICI）治疗相关的罕见不良事件（<1%），称为免疫治疗相关血小板减少症（irTP）。由于发生危及生命的出血并发症的风险增加，这种情况在转移性骨癌患者中尤为令人担忧，这可能会进一步影响患者的治疗管理。此外，关于该人群中irTP的系统性报告稀缺，凸显了进行重点研究的必要性。
我们回顾性分析了2020年5月至2024年12月期间在三家三级医院接受单药ICI治疗（具体为帕博利珠单抗、派安普利单抗和信迪利单抗等PD-1抑制剂）的转移性骨癌患者的临床记录。发生严重irTP的患者纳入分析。
共筛查94例患者，其中7例（7.45%）被诊断为严重irTP。原发癌亚型包括黑色素瘤（n = 4）、未分化多形性肉瘤（n = 2）和肾透明细胞癌（n = 1）。所有7例患者均在接受骨吸收抑制剂地诺单抗的联合治疗。irTP发病的中位时间为首次使用ICI后92天。确诊后，所有患者均住院并接受强化免疫调节治疗、支持治疗和精心的护理管理。虽然所有病例症状均有显著改善，但长期随访表明患者出院后病情保持稳定。中位住院时间为18天。
尽管文献中认为irTP罕见，但我们在队列中观察到的发病率为7.45%，这凸显了转移性骨癌患者因严重出血并发症风险而引起的重大临床关注。及时诊断和综合治疗——在肿瘤学家、血液学家和护理人员的跨学科协作支持下——对于实现完全康复至关重要。此外，我们的研究结果强调了未来对irTP预测生物标志物和危险因素进行研究的必要性。
