Li Yingying, Jiang Huiwen, Luo Lili, Mei Heng
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Dadao, Wuhan, 430022, Hubei, China.
Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan, 430022, China.
Ann Hematol. 2025 Jul;104(7):3537-3551. doi: 10.1007/s00277-025-06482-z. Epub 2025 Jul 1.
Immunotherapy, encompassing immune checkpoint inhibitors, antibody therapy, and chimeric antigen receptor (CAR)-T-cell therapy, has emerged as a groundbreaking approach by harnessing the immune system to selectively target and eliminate malignant cells. However, its widespread application has revealed a spectrum of severe, life-threatening hemostatic abnormalities, including immune thrombocytopenia, Evans syndrome, thrombotic thrombocytopenic purpura, acquired haemophilia A, thrombosis, disseminated intravascular coagulation and CAR-T-associated coagulopathy. These disorders may arise from excessive immune activation, autoantibody production, and intricate crosstalk between inflammatory pathways and coagulation cascades. Despite increasing recognition, their pathophysiological mechanisms remain incompletely understood, and standardized management strategies have yet to be established, posing significant clinical challenges. Given the safety concerns surrounding immunotherapy, timely diagnosis and appropriate intervention of these abnormalities are crucial. This review provides a comprehensive overview of the epidemiology, distinct clinical manifestations, emerging pathophysiological insights, and evolving treatment paradigms of immunotherapy-associated hemostatic abnormalities to enhance clinicians' understanding and guide therapeutic decision-making.
免疫疗法，包括免疫检查点抑制剂、抗体疗法和嵌合抗原受体（CAR）-T细胞疗法，已成为一种开创性的方法，通过利用免疫系统选择性地靶向和消除恶性细胞。然而，其广泛应用已揭示出一系列严重的、危及生命的止血异常，包括免疫性血小板减少症、伊文氏综合征、血栓性血小板减少性紫癜、获得性血友病A、血栓形成、弥散性血管内凝血和CAR-T相关凝血病。这些疾病可能源于过度的免疫激活、自身抗体产生以及炎症途径与凝血级联之间复杂的相互作用。尽管认识不断提高，但其病理生理机制仍未完全了解，标准化管理策略尚未建立，这带来了重大的临床挑战。鉴于免疫疗法的安全性问题，及时诊断和适当干预这些异常至关重要。本综述全面概述了免疫疗法相关止血异常的流行病学、独特临床表现、新出现的病理生理见解以及不断演变的治疗模式，以增强临床医生的理解并指导治疗决策。
