| Title: |
A wolf in sheep's clothing: systemic immune activation post immunotherapy |
| Authors: |
Tiu, C; Shinde, R; Pal, A; Biondo, A; Lee, A; Tunariu, N; Jhanji, S; Grover, V; Tatham, K; Gruber, P; Banerji, U; De Bono, JS; Nicholson, E; Minchom, AR; Lopez, JS |
| Source: |
195 ; 189 |
| Publisher Information: |
Innovative Healthcare Institute |
| Publication Year: |
2021 |
| Collection: |
Imperial College London: Spiral |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
Journal of Immunotherapy and Precision Oncology; http://hdl.handle.net/10044/1/95155 |
| DOI: |
10.36401/jipo-21-9 |
| Availability: |
http://hdl.handle.net/10044/1/95155; https://doi.org/10.36401/jipo-21-9 |
| Rights: |
© 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/) ; https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Accession Number: |
edsbas.2F81BEC8 |
| Database: |
BASE |