PD-1 Checkpoint Blockade in Patients for Acute Myeloid Leukemia after HSCT Relapse Resulted in Severe GVHD and sHLH

Treatment with immune checkpoint inhibitors (ICI) such as carrizumab leads to immune-mediated adverse effects including severe acute graft versus host disease (aGVHD) and secondary hemophagocytic syndrome (sHLH). Herein, we present two cases where aGVHD and sHLH developed after ICI administration, w...

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Bibliographic Details
Published in:Case reports in hematology 2022-12, Vol.2022, p.1705905-4
Main Authors: Du, Zhi zhuo, Zhou, Mi, Ling, Jing, Cao, Lan, Kong, Lingjun, Cheng, Shengqin, Xiao, Peifang, Hu, Shaoyan
Format: Article
Language:English
Subjects:
Bone marrow
Case Report
Case reports
Chemotherapy
Complications and side effects
Corticosteroids
Diarrhea
Disease prevention
Diseases
Fever
Immunosuppressive agents
Ipilimumab
Leukemia
Liver
Lung cancer
Lymphocytes
Lymphoma
Medical prognosis
Methotrexate
Mortality
Patients
Political aspects
Relapse
Skin
Transplants & implants
Tumors
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Summary:Treatment with immune checkpoint inhibitors (ICI) such as carrizumab leads to immune-mediated adverse effects including severe acute graft versus host disease (aGVHD) and secondary hemophagocytic syndrome (sHLH). Herein, we present two cases where aGVHD and sHLH developed after ICI administration, which was treated using methylprednisolone (MP). They developed high-grade fever complicated with liver dysfunction and diarrhea 1 day after ICI administration. Treatment with MP does not alleviate symptoms because of steroid resistance. Hyperbilirubinemia, rash with blisters, and watery diarrhea showed severe aGVHD. Hyperferritinemia, hypertriglyceridemia, and cytopenias suggested the diagnosis of HLH and met the criteria for sHLH diagnosis. They were thus administered intravenous high-dose MP, methotrexate (MTX), basiliximab, ruxolitinib, etc, which resolved these symptoms.
ISSN:2090-6560
2090-6579
DOI:10.1155/2022/1705905