PDF(Pubmed)
Abstract：
Immune checkpoint inhibitor-related thrombocytopenia (irTCP) is a relatively rare immune-related adverse event (irAE); however, overall survival may worsen when it occurs. Prolonged use of high-dose steroids can diminish the effectiveness of immune checkpoint inhibitor (ICI) therapy on the primary disease because of T lymphocyte suppression, thus early tapering is necessary. We experienced a rare case of a 79-year-old male who concurrently developed irTCP and multiple myeloma (MM) during treatment with ICIs for lung adenocarcinoma. The patient exhibited severe thrombocytopenia and elevated serum IgA levels. Based on various tests, we diagnosed MM and irTCP. Despite administering the standard bortezomib plus dexamethasone (Bd therapy) treatment for MM, there was no response and the irTCP was steroid-resistant. Consequently, we administered a regimen including daratumumab (DPd therapy) for steroid-resistant irTCP and refractory MM, which resulted in a response. As a result, we were able to avoid prolonged use of high-dose steroids and the patient is stable without exacerbation of lung adenocarcinoma for 1 year and 5 months after the onset of MM. To our knowledge, there are no cases of MM developing during ICI treatment and this is the first case report in which daratumumab was effective for the treatment of irTCP.
摘要：
免疫检查点抑制剂相关的血小板减少症(irTCP)是一种相对罕见的免疫相关不良事件(irAE);然而,总生存期可能会恶化。由于T淋巴细胞抑制，长期使用高剂量类固醇可以降低免疫检查点抑制剂（ICI）治疗对原发疾病的有效性。因此，早期缩减是必要的。我们经历了一例罕见的79岁男性病例，该男性在使用ICIs治疗肺腺癌期间同时发展为irTCP和多发性骨髓瘤（MM）。患者表现出严重的血小板减少症和血清IgA水平升高。根据各种测试，我们诊断MM和irTCP。尽管使用硼替佐米加地塞米松（Bd疗法）治疗MM，无反应，irTCP对类固醇耐药。因此,我们对类固醇耐药的irTCP和难治性MM进行了包括达雷妥单抗（DPd治疗）的治疗方案，这导致了一个回应。因此,我们避免了长时间使用大剂量类固醇,且患者在MM发病后1年零5个月内病情稳定,未出现肺腺癌恶化.据我们所知,在ICI治疗期间没有发生MM病例,这是首例达雷妥单抗对irTCP治疗有效的病例报告.
