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暴发性心肌炎和联合免疫检查点阻断疗法之间的关系
Fulminant Myocarditis with Combination Immune Checkpoint Blockade


Douglas B. Johnson ... 心脑血管疾病 肿瘤 • 2016.11.03
相关阅读
• 与检查点抑制疗法相关的免疫相关不良事件 • 经历免疫检查点抑制剂治疗的患者中的心肌炎 • 抗PD-1药物的免疫相关不良事件 • 免疫检查点阻断诱发的免疫相关不良事件 • 免疫检查点抑制剂治疗癌症后的神经系统免疫相关不良事件 • 免疫检查点抑制剂给癌症治疗带来了彻底变革

概述


免疫检查点抑制剂已经改善了很多与癌症相关的临床结局,但是其使用会发生高度、免疫相关不良事件,尤其是在联合免疫治疗时。我们报道2个黑色素瘤病例,这2个病例在采用伊匹木单抗和纳武利尤单抗后发生了致死性心肌炎。这2例患者都发生了伴有横纹肌溶解的肌炎、早期进展性和顽固性心脏电不稳定,以及有大量T细胞和巨噬细胞浸润的心肌炎。浸润心肌的选择性克隆T细胞群与肿瘤和骨骼肌中存在的T细胞相同。药物警戒研究显示,0.27%接受伊匹木单抗和纳武利尤单抗联合治疗的患者发生心肌炎,这表明我们的患者存在罕见、潜在致死性、T细胞驱动的药物反应(由Vanderbilt–Ingram Cancer Center Ambassadors等资助)。





作者信息

Douglas B. Johnson, M.D., Justin M. Balko, Pharm.D., Ph.D., Margaret L. Compton, M.D., Spyridon Chalkias, M.D., Joshua Gorham, B.A., Yaomin Xu, Ph.D., Mellissa Hicks, Ph.D., Igor Puzanov, M.D., Matthew R. Alexander, M.D., Ph.D., Tyler L. Bloomer, M.D., Jason R. Becker, M.D., David A. Slosky, M.D., Elizabeth J. Phillips, M.D., Mark A. Pilkinton, M.D., Ph.D., Laura Craig-Owens, M.D., Nina Kola, M.D., Gregory Plautz, M.D., Daniel S. Reshef, M.D., M.P.H., Ph.D., Jonathan S. Deutsch, M.D., Raquel P. Deering, Ph.D., Benjamin A. Olenchock, M.D., Ph.D., Andrew H. Lichtman, M.D., Dan M. Roden, M.D., Christine E. Seidman, M.D., Igor J. Koralnik, M.D., Jonathan G. Seidman, Ph.D., Robert D. Hoffman, M.D., Ph.D., Janis M. Taube, M.D., Luis A. Diaz, Jr., M.D., Robert A. Anders, M.D., Jeffrey A. Sosman, M.D., and Javid J. Moslehi, M.D.
Address reprint requests to Dr. Moslehi at the Cardio-oncology Program, Vanderbilt University Medical Center, 2220 Pierce Ave., Nashville, TN 37232, or at javid.moslehi@vanderbilt.edu.

 

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