Literature case analysis of hemophagocytic lymphohistiocytosis due to immune checkpoint inhibitors
10.3760/cma.j.cn114015-20240305-00131
- VernacularTitle:免疫检查点抑制剂致噬血细胞性淋巴组织细胞增生症文献病例分析
- Author:
Shen'ao JING
1
;
Shengnan QIU
;
Chenghao LI
;
Xin HUANG
Author Information
1. 山东第一医科大学第一附属医院（山东省千佛山医院）药学部，济南 250014
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Lymphohistiocytosis, hemophagocytic;
Blood cell count;
Bone marrow examination;
Ferritins;
Drug-related side effect and adver
- From:
Adverse Drug Reactions Journal
2024;26(8):480-486
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the clinical characteristics of hemophagocytic lymphohistiocytosis (HLH) induced by immune checkpoint inhibitors (ICIs).Methods:Relevant databases at home and abroad (up to February 15, 2024) were searched and case reports of HLH induced by ICIs were collected. Relevant information of patients (gender, age, primary disease), usage and dosage of ICI, combined drugs, occurrence time, clinical manifestations, management, and outcomes of HLH were extracted and analyzed descriptively and statistically.Results:A total of 37 case reports were enrolled in the analysis, involving 44 patients. Of them, 26 patients were male and 18 were female. The age ranged from 2 to 86 years, with a median age of 67 years. The primary diseases included melanoma in 14 patients, lung cancer in 12 patients, kidney cancer in 4 patients, oral squamous cell carcinoma and acute myeloid leukemia in 2 patients each, and other 10 malignant tumors in one patient each. A total of 8 ICIs were used, including pembrolizumab in 17 patients, nivolumab in 10 patients, nivolumab combined with ipilimumab in 8 patients, atezolizumab, camrelizumab, and ipilimumab in 2 patients each, and toripalimab, tislelizumab, and avelumab in 1 patient each. Among them, 33 patients received single ICI immunotherapy, 6 patients received immunotherapy combined with targeted therapy, and 5 patients received immunotherapy combined with chemotherapy. Twenty-two patients had medication dosage records, and the administration method was all intravenous infusion. The shortest time for HLH occurrence was 1 day after medication, the longest was 8 months, and the median time was 5 days. The clinical manifestations included recurrent fever, fatigue, loss of appetite, etc. Laboratory and auxiliary examinations showed decreased blood cells, elevated ferritin, increased hemophagocytic cells, and spleen enlargement. After the diagnosis of HLH, 40 cases discontinued the drug, 1 did not stop, and 3 were unknown. Forty-two patients received symptomatic treatments, of which 18 patients returned to normal, 17 patients were improved, 1 patient was unknown, and 6 patients died. Two patients who did not receive intervention died.Conclusions:The main clinical symptoms of ICI-related HLH are fever, fatigue, weakness, loss of appetite, and hemophagocytosis. Withdrawal and symptomatic treatments can effectively improve the symptoms of patients, but HLH has a higher risk of death.
