与西班牙免疫检查点抑制剂相关的神经不良事件:一项回顾性队列研究
Elianet Fonseca1, Jose M Cabrera-Maqueda2, Raquel Ruiz-García3
1Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
The Lancet. Neurology
|November 17, 2023
概括
免疫检查点抑制剂产生的神经免疫相关不良事件 (irAEs) 通常涉及中枢神经系统,缺乏抗体. 肺癌和特异性脑病变的呈现独立地预测死亡率,大多数死亡发生在早期.
科学领域:
- 神经免疫学 神经免疫学
- 在瘤学瘤学.
- 临床神经学 临床神经学
背景情况:
- 免疫检查点抑制剂 (ICI) 可以引起神经系统免疫相关的不良事件 (irAEs),呈现不同.
- 对于神经性irrAEs的综合征和预后因素仍然不太了解,特别是在脑病变患者中.
研究的目的:
- 描述和分组神经性IRAE的临床特征.
- 确定神经性irAEs患者治疗反应和生存的预测因素.
- 专注于呈现脑病变的患者.
主要方法:
- 在西班牙20家医院进行了回顾性观察性研究.
- 包括ICI后的神经性IRAE的患者,不包括那些有先前存在的疾病的患者.
- 分析临床数据,血清和脑液样本;评估神经抗体;在1个月和最后一次随访时评估神经状态.
主要成果:
- 包括64名患者;中位数年龄67岁;66%男性;主要瘤:肺癌 (47%),黑色素瘤 (21%).
- 81%的中枢神经系统参与;70%的脑病变. 在22%的患者中检测到神经抗体.
- 18%的病情在1个月内没有改善,11人死亡. 肺癌和没有炎症的特异性脑病变呈现的死亡率增加.
结论:
- 大多数神经性IRE影响中枢神经系统,并且是抗体负的.
- 心肌炎,肌,肌炎,没有炎症的脑病变和肺癌是死亡率的独立预测因素.
- 建议在患有神经性irrAEs的患者早期和密集治疗,因为早期死亡率很高.
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