胃肠道免疫检查点抑制剂毒性的随访活检可能会显示明显不同的炎症模式,而不是最初的伤害
Nicole K Tomm1, Julianne M Szczepanski1, Jiayun M Fang1
1Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Bldg 35, Ann Arbor, MI, 48109, USA.
Human pathology
|May 11, 2024
概括
免疫检查点抑制剂 (ICI) 大肠炎的组织学可以随着时间的推移而改变. 随访活检显示不同的模式,甚至IBD-like,往往仍然是ICI毒性,特别是在重新开始ICI治疗后.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 病理学 病理学 病理学
背景情况:
- 免疫检查点抑制剂 (ICI) 可以引起大肠炎,这是一个常见的毒性.
- ICI大肠炎的组织学模式各不相同,并且可能与特定的ICI药物相关.
- 有限的数据存在于ICI大肠炎的纵向组织学变化.
研究的目的:
- 为了评估患者治疗ICI随着时间的推移大肠炎的组织学模式的变化.
- 为了确定组织学变化是否与ICI再暴露或药物类型相关.
- 评估ICI大肠炎中不断变化的组织学的诊断影响.
主要方法:
- 从30名ICI大肠炎患者的初始和随访活检的回顾性审查.
- 组织学模式的分析和与ICI治疗状态的相关性 (重新挑战,药物类型).
- 症状和治疗反应的临床相关性.
主要成果:
- 37%的患者在随访活检时显示出不同的组织学模式.
- 在重新开始ICI治疗的患者中,组织学变化更频繁 (64%vs11%).
- 许多患者出现了类似炎症性肠病 (IBD) 的模式 (36%),但在ICI停药后,症状在不使用类固醇的情况下消失.
结论:
- 在ICI大肠炎中,组织学可能会演变,在三分之一以上的患者中观察到变化.
- 组织学演变,包括IBD类型的模式,并不一定表明IBD de novo.
- 在ICI停药后持续的症状缓解支持ICI毒性作为潜在的原因,即使有不断变化的组织学.
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