| 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 |
| Contributors: |
Tiu, Crescens; Tunariu, Nina; Banerji, Udai; De Bono, Johann; Minchom, Anna; Lopez, Juanita |
| Publisher Information: |
Innovative Healthcare Institute |
| Publication Year: |
2022 |
| Collection: |
The Institute of Cancer Research (ICR): Publications Repository |
| Subject Terms: |
HLH; fever; immune checkpoint inhibitor; immune-related adverse events; systemic immune activation; toxicity |
| Subject Geographic: |
United States |
| 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 |
| File Description: |
Electronic-eCollection; 195; application/pdf |
| Language: |
English |
| ISSN: |
2590-017X; 2666-2345 |
| Relation: |
J Immunother Precis Oncol, 2021, 4 (4), pp. 189 - 195; https://repository.icr.ac.uk/handle/internal/5445 |
| Availability: |
https://repository.icr.ac.uk/handle/internal/5445 |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.6CC94EE7 |
| Database: |
BASE |