派姆单抗治疗后类固醇难治性自身免疫性心肌炎:马抗胸腺细胞球蛋白预防心衰的失败。

Journal of clinical case reports Pub Date : 2019-01-15
N V Baclig, C Ngo, A C Yeh, S H Chung, A Cheng, J Grim, S A Graf, K C Yang
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引用次数: 0

摘要

虽然免疫检查点抑制剂(ICIs)正在改善许多癌症的预后,但它们可能有严重的副作用。虽然心脏免疫相关不良反应(irAEs)是罕见的,但它们有相当高的发病率和死亡率。先前的病例研究已经证明,使用多种免疫抑制方案成功治疗ICI诱导的自身免疫性心肌炎。本病例描述了用派姆单抗治疗后类固醇难治性自身免疫性心肌炎。马抗胸腺细胞球蛋白治疗,一种先前记录的逆转ICI诱导的自身免疫性心肌炎的方案,暂时改善了临床状态和心脏生物标志物,但最终未能阻止心力衰竭和心血管死亡的进展。该病例强调了早期应激剂量类固醇的重要性,确定了肌钙蛋白作为治疗反应的潜在标志,并强调了肿瘤学和心脏病学之间合作的价值,以实现最佳管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Steroid-Refractory Autoimmune Myocarditis after Pembrolizumab Therapy: Failure of Equine Anti-Thymocyte Globulin to Prevent Heart Failure.

While immune checkpoint inhibitors (ICIs) are improving outcomes for many cancers, they can have severe adverse effects. Though cardiac immune-related adverse effects (irAEs) are rare, they have considerable morbidity and mortality. Prior case studies have demonstrated successful treatment of ICI induced autoimmune myocarditis with a variety of immunosuppressive regimens. This case describes steroid-refractory autoimmune myocarditis after treatment with pembrolizumab. Treatment with equine anti-thymocyte globulin, a regimen previously documented to reverse ICI induced autoimmune myocarditis, temporarily improved clinical status and cardiac biomarkers, however eventually failed to prevent progression to heart failure and cardiovascular death. This case highlights the importance of early stress-dose steroids, identifies troponin as a potential marker of treatment response, and underscores the value of collaboration between oncology and cardiology for optimal management.

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