A Wolf in Sheep's Clothing: Systemic Immune Activation Post Immunotherapy.
HLH
fever
immune checkpoint inhibitor
immune-related adverse events
systemic immune activation
toxicity
Journal
Journal of immunotherapy and precision oncology
ISSN: 2590-017X
Titre abrégé: J Immunother Precis Oncol
Pays: United States
ID NLM: 101768397
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
23
04
2021
revised:
08
07
2021
accepted:
09
07
2021
entrez:
6
6
2022
pubmed:
7
6
2022
medline:
7
6
2022
Statut:
epublish
Résumé
Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH). All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection. Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH. SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.
Identifiants
pubmed: 35665022
doi: 10.36401/JIPO-21-9
pmc: PMC9138480
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
189-195Déclaration de conflit d'intérêts
Source of Support: None. Conflict of Interest: None.
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