A wolf in sheep's clothing: systemic immune activation post immunotherapy
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Introduction:
Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH).
Methods:
All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection.
Results:
Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH.
Conclusion:
SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.
Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH).
Methods:
All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection.
Results:
Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH.
Conclusion:
SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.
Date Issued
2021-11-01
Date Acceptance
2021-07-09
Citation
Journal of Immunotherapy and Precision Oncology, 2021, 4 (4), pp.189-195
ISSN
2666-2345
Publisher
Innovative Healthcare Institute
Start Page
189
End Page
195
Journal / Book Title
Journal of Immunotherapy and Precision Oncology
Volume
4
Issue
4
Copyright Statement
© 2021 The Author(s). This work is published under a CC-BY-NC-ND 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Publication Status
Published
Date Publish Online
2021-09-07