Fulminant Myocarditis with Combination Immune Checkpoint Blockade.

Douglas B Johnson1, Justin M Balko1, Margaret L Compton1

  • 1From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore.

Summary

Fatal myocarditis is a rare, T-cell-driven adverse event in melanoma patients receiving combination immunotherapy (ipilimumab and nivolumab). This immune-related adverse event involves myositis, cardiac instability, and T-cell infiltration.

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