Autoimmune hemolytic anemia associated with the use of immune checkpoint inhibitors for cancer: 68 cases from the Food and Drug Administration database and review.
Adult
Aged
Aged, 80 and over
Anemia, Hemolytic, Autoimmune
/ epidemiology
Antineoplastic Agents, Immunological
/ adverse effects
Biomarkers, Tumor
Databases, Factual
Female
Humans
Male
Middle Aged
Molecular Targeted Therapy
/ adverse effects
Neoplasms
/ complications
United States
/ epidemiology
United States Food and Drug Administration
autoimmune hemolytic anemia
checkpoint inhibitors
immune-related adverse events
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
14
09
2018
revised:
13
10
2018
accepted:
15
10
2018
pubmed:
23
10
2018
medline:
26
4
2019
entrez:
23
10
2018
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (CPI) are widely used in modern oncology and have improved the prognosis of lung cancer, malignant melanoma, and other malignancies. Unlike cytotoxic chemotherapy, drugs such as nivolumab, pembrolizumab, and ipilimumab are associated with immune-related adverse effects. We recently observed a patient with lung cancer who developed a fulminant warm antibody autoimmune hemolytic anemia (AIHA). Investigate the frequency and prognosis of AIHA secondary to CPI in a public database and review the literature. A total of 68 cases were identified in the database of the Food and Drug Administration (FDA), 43 were associated with nivolumab, 13 with pembrolizumab, seven with ipilimumab, and five with atezolizumab. All episodes of AIHA were listed as serious. If the total number of adverse events cases reported to the FDA is taken as a reference, AIHA is rare, but occurred more frequently with PD-1 or PD-L1 targeting agents (0.15%-0.25%) than with CTLA-4 inhibitors (0.06%). In addition to our case, the literature review identified 11 similar cases. Most cases of AIHA responded to steroids, but two of 12 were fatal. We describe AIHA as a new and serious immune-related side effect of CPI. Early aggressive management is necessary.
Sections du résumé
BACKGROUND
BACKGROUND
Immune checkpoint inhibitors (CPI) are widely used in modern oncology and have improved the prognosis of lung cancer, malignant melanoma, and other malignancies. Unlike cytotoxic chemotherapy, drugs such as nivolumab, pembrolizumab, and ipilimumab are associated with immune-related adverse effects. We recently observed a patient with lung cancer who developed a fulminant warm antibody autoimmune hemolytic anemia (AIHA).
OBJECTIVES
OBJECTIVE
Investigate the frequency and prognosis of AIHA secondary to CPI in a public database and review the literature.
RESULTS
RESULTS
A total of 68 cases were identified in the database of the Food and Drug Administration (FDA), 43 were associated with nivolumab, 13 with pembrolizumab, seven with ipilimumab, and five with atezolizumab. All episodes of AIHA were listed as serious. If the total number of adverse events cases reported to the FDA is taken as a reference, AIHA is rare, but occurred more frequently with PD-1 or PD-L1 targeting agents (0.15%-0.25%) than with CTLA-4 inhibitors (0.06%). In addition to our case, the literature review identified 11 similar cases. Most cases of AIHA responded to steroids, but two of 12 were fatal.
CONCLUSION
CONCLUSIONS
We describe AIHA as a new and serious immune-related side effect of CPI. Early aggressive management is necessary.
Substances chimiques
Antineoplastic Agents, Immunological
0
Biomarkers, Tumor
0
Types de publication
Case Reports
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
157-162Informations de copyright
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.