دورية أكاديمية
Presumed complement-mediated, checkpoint inhibitor-induced, thrombotic microangiopathy in a patient with metastatic melanoma.
| العنوان: | Presumed complement-mediated, checkpoint inhibitor-induced, thrombotic microangiopathy in a patient with metastatic melanoma. |
|---|---|
| المؤلفون: | Muniz TP; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada thiago.muniz@uhn.ca., Patriquin CJ; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Saibil SD; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. |
| المصدر: | BMJ case reports [BMJ Case Rep] 2021 Jul 26; Vol. 14 (7). Date of Electronic Publication: 2021 Jul 26. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101526291 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-790X (Electronic) Linking ISSN: 1757790X NLM ISO Abbreviation: BMJ Case Rep Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BMJ Pub. Group |
| مواضيع طبية MeSH: | Melanoma*/drug therapy , Thrombotic Microangiopathies*/chemically induced, Aged ; Complement Inactivating Agents ; Humans ; Ipilimumab/adverse effects ; Male ; Nivolumab/adverse effects |
| مستخلص: | Immune checkpoint inhibitors (ICIs) are associated with a variety of immune-related adverse events (irAEs), but haematological irAEs are rare. We report a case of presumed complement-mediated thrombotic microangiopathy (CM-TMA) in a 78-year-old man with metastatic melanoma following treatment with ICIs. Following two doses of combination nivolumab and ipilimumab therapy, he developed microangiopathic haemolytic anaemia, thrombocytopenia and increased creatinine. ADAMTS13 activity was preserved, CH50 was high, haptoglobin was depleted and a blood film demonstrated fragments. Given this constellation of findings, a diagnosis of CM-TMA was made. Immunotherapy was held and the patient received steroids and supportive care. Six months after his last dose of immunotherapy, he has no evidence of melanoma or CM-TMA. CM-TMA should be suspected in patients on ICI with unexplained anaemia and thrombocytopenia with preserved ADAMTS13 activity. Suspicion of complement dysregulation may have therapeutic implications, such as the necessity of complement pathway inhibition. Competing Interests: Competing interests: CP has received speaking honoraria and educational grant from Alexion and Octapharma and has also worked on the advisory board of Alexion. SDS has worked on advisory boards for Novartis and Janssen. (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.) |
| References: | Front Med (Lausanne). 2020 May 22;7:212. (PMID: 32528969) J Immunother Cancer. 2019 Nov 15;7(1):306. (PMID: 31730012) N Engl J Med. 2014 Aug 14;371(7):654-66. (PMID: 25119611) J Immunother Cancer. 2017 Mar 21;5:19. (PMID: 28344807) N Engl J Med. 2019 Oct 17;381(16):1535-1546. (PMID: 31562797) CEN Case Rep. 2020 Aug;9(3):289-290. (PMID: 32002819) J Immunother Cancer. 2017 Nov 21;5(1):95. (PMID: 29162153) Kidney Int. 2019 Jul;96(1):67-79. (PMID: 30910380) Front Med (Lausanne). 2020 Oct 06;7:569291. (PMID: 33117830) J Oncol Pharm Pract. 2020 Jul;26(5):1237-1240. (PMID: 31718453) Case Rep Hematol. 2018 Dec 20;2018:2464619. (PMID: 30671268) J Immunol. 2018 Apr 1;200(7):2464-2478. (PMID: 29500241) N Engl J Med. 2013 Jun 6;368(23):2169-81. (PMID: 23738544) |
| فهرسة مساهمة: | Keywords: haematology (incl blood transfusion); oncology; skin cancer |
| المشرفين على المادة: | 0 (Complement Inactivating Agents) 0 (Ipilimumab) 31YO63LBSN (Nivolumab) |
| تواريخ الأحداث: | Date Created: 20210727 Date Completed: 20210728 Latest Revision: 20230727 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC8314688 |
| DOI: | 10.1136/bcr-2021-242075 |
| PMID: | 34312126 |
| قاعدة البيانات: | MEDLINE |
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