Ma Xue, Qin Xing
Department of Neurology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China.
Front Immunol. 2025 Aug 27;16:1595653. doi: 10.3389/fimmu.2025.1595653. eCollection 2025.
Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1), programmed cell death protein 1 ligand, and cytotoxic T-lymphocyte-associated protein 4, are important therapeutic approaches for malignancies. However, these novel treatment measures are associated with immune-related adverse events. We report the first reported case of autoimmune GFAP astrocytopathy-associated myelitis in a patient with hepatocellular carcinoma that was treated with sintilimab (an anti-PD-1 monoclonal antibody) immunotherapy. Additionally, literature review identified 21 previously reported cases of PD-1 inhibitor-associated myelitis, demonstrating similar clinical features. All patients received ICI discontinuation and high-dose glucocorticoid therapy, with the addition of other immune therapies in 15 patients. Clinical improvement was observed in 13 patients. Clinicians should consider autoimmune GFAP astrocytopathy-associated myelitis as a potential differential diagnosis among patients exhibiting neurological symptoms during or following ICI therapy.
靶向程序性细胞死亡蛋白1（PD-1）、程序性细胞死亡蛋白1配体和细胞毒性T淋巴细胞相关蛋白4的免疫检查点抑制剂（ICIs）是恶性肿瘤的重要治疗方法。然而，这些新的治疗措施与免疫相关不良事件有关。我们报告了首例在接受信迪利单抗（一种抗PD-1单克隆抗体）免疫治疗的肝细胞癌患者中发生的与自身免疫性胶质纤维酸性蛋白星形细胞病相关的脊髓炎病例。此外，文献回顾确定了21例先前报道的与PD-1抑制剂相关的脊髓炎病例，显示出相似的临床特征。所有患者均停用ICI并接受大剂量糖皮质激素治疗，15例患者还加用了其他免疫疗法。13例患者观察到临床改善。临床医生应将与自身免疫性胶质纤维酸性蛋白星形细胞病相关的脊髓炎视为ICI治疗期间或之后出现神经症状患者的潜在鉴别诊断。
