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在接受免疫检查点抑制剂治疗的患者中患有严重神经衰竭
Abdulrahman Alghabban1, Lucy Corke1, Hans Katzberg2
1Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
JTO clinical and research reports
|April 17, 2025
概括
免疫检查点抑制剂 (ICI) 很少会导致严重的神经疾病 - - 肌痛性硬化症 (MG). 早期诊断和治疗对于管理这种罕见但可能致命的ICI副作用至关重要.
科学领域:
- 在瘤学瘤学.
- 神经学 神经学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 改变了癌症治疗,导致它们在早期疾病阶段和组合疗法中使用.
- 虽然ICI通常是安全的,但可以引起与免疫相关的不良事件,包括罕见但严重的神经毒性,如严重肌痛性肌痛症 (MG).
- 对于常见的ICI毒性存在管理指南,但由于高发病率和死亡率,像MG这样的神经学并发症存在独特的挑战.
研究的目的:
- 调查免疫检查点抑制剂 (ICI) 治疗后发生肌痛性肌痛症 (MG) 的患者的临床特征,治疗和结果.
- 突出与ICI相关的MG相关的诊断和管理挑战,特别是在阴性血清学标记或重叠综合征的情况下.
主要方法:
- 进行了单个中心的回顾性图表审查.
- 抽象的数据包括MG后ICI治疗诊断的个体表现出症状,接受治疗和患者结果.
主要成果:
- 十六名患者在ICI治疗后发展出MG;11人患有并发性肌肉炎.
- 症状出现的中位时间为49天.
- 虽然大多数患者接受了类固醇治疗,有些人需要额外的免疫抑制或血交换,但结果各不相同:2例完全解决,8例改善残留症状,2例初步改善,然后恶化,4例恶化.
- 死亡率显著,38%的人死于MG并发症,19%的人死于进展性癌症.
结论:
- 与免疫检查点抑制剂相关的骨髓灰质炎是一种罕见的,可能致命的不良事件,需要迅速识别和多学科管理.
- 诊断挑战,包括负血清学标志物和重叠综合征,导致高死亡率.
- 临床医生应保持诊断和启动ICI相关的MG早期治疗的低门.
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