Macrophage activation syndrome: A new complication of checkpoint inhibitors

Malissen, Nausicaa; Lacotte, J.; Du‐Thanh, Aurélie; Gaudy‐Marqueste, C.; Guillot, B.; Grob, Jean‐Jacques

doi:10.1016/j.ejca.2017.02.016

Cited by 31 publications

(29 citation statements)

References 5 publications

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“…HLH, an uncommon but previously described and potentially fatal hematologic disorder , was also reported in 26 cases. HLH can be triggered by underlying malignancy but has also been described as complicating ICIs.…”

Section: Resultsmentioning

confidence: 98%

Hematologic Complications of Immune Checkpoint Inhibitors

et al. 2019

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Section: Resultsmentioning

confidence: 98%

Hematologic Complications of Immune Checkpoint Inhibitors

et al. 2019

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“…29 According to current reports, most patients only received high doses of prednisone or prednisolone 1-2 mg/kg, and a few were combined with mycophenolate mofetil or rituximab. 7,[30][31][32] It is recommended to use standard or high dose corticosteroids combined with etoposide based on the HLH international protocol. If front-line treatment fails, biological therapy (such as rituximab, infliximab, and etanercept), anti-interleukin-6 (tocilizumab) should be considered.…”

Section: Treatmentmentioning

confidence: 99%

“…from China combined liposomal doxorubicin, etoposide, and methylprednisolone as a promising salvage regimen in adult refractory HLH patients . According to current reports, most patients only received high doses of prednisone or prednisolone 1–2 mg/kg, and a few were combined with mycophenolate mofetil or rituximab …”

Section: Introductionmentioning

confidence: 99%

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related hematological adverse events

Zhuang

Guo

et al. 2020

Thoracic Cancer

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Immune checkpoint inhibitors (ICIs) are able to reactivate the immune system, thereby enhancing the anti‐tumor effects. However, over‐activated T cells may induce immune‐related adverse events (irAEs). Hematological irAEs are rarely reported which mainly represent monolineage cytopenia or pancytopenia, including autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), neutropenia and aplastic anemia, sometimes even life‐threatening diseases such as hemophagocytic lymphohistiocytosis. Here, the clinical manifestations of hematological irAEs are summarized and recommendations for diagnosis and treatment proposed. Key points Significant findings of the study• Hematological immune‐related adverse events (irAEs) caused by checkpoint inhibitors are rare and may sometimes be life‐threatening. This study summarizes the manifestations of hematological irAEs and proposes preliminary recommendations for diagnosis and treatment. What this study adds• Much still remains unknown regarding hematological irAEs caused by checkpoint inhibitors. This study delineates the overview of hematological irAEs, and provides practical treatment suggestions, in particular addressing the issue of rechallenge.

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“…The overall response rates against melanoma, bladder cancer, Hodgkin's lymphoma and non‐small cell lung cancer using ICIs is approximately 30%, and complete response rates (eradication of a patient's tumors) are as low as 5% . Recently, macrophage activation syndrome (MAS), a very severe, new complication of ICIs with a 50% mortality rate, has been reported . More serious concerns have clearly been raised about the clinical use of ICIs.…”

Section: Cardiotoxicity Induced By Icis and T‐cell Therapymentioning

confidence: 99%

“…566 Recently, macrophage activation syndrome (MAS), a very severe, new complication of ICIs with a 50% mortality rate, has been reported. 567 More serious concerns have clearly been raised about the clinical use of ICIs.…”

Section: Cardiotoxicity Induced By Icis and T-cell Therapymentioning

confidence: 99%

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps, challenges, and insights

Zheng

Kros

2017

Medicinal Research Reviews

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To date, five cancer treatment modalities have been defined. The three traditional modalities of cancer treatment are surgery, radiotherapy, and conventional chemotherapy, and the two modern modalities include molecularly targeted therapy (the fourth modality) and immunotherapy (the fifth modality). The cardiotoxicity associated with conventional chemotherapy and radiotherapy is well known. Similar adverse cardiac events are resurging with the fourth modality. Aside from the conventional and newer targeted agents, even the most newly developed, immune‐based therapeutic modalities of anticancer treatment (the fifth modality), e.g., immune checkpoint inhibitors and chimeric antigen receptor (CAR) T‐cell therapy, have unfortunately led to potentially lethal cardiotoxicity in patients. Cardiac complications represent unresolved and potentially life‐threatening conditions in cancer survivors, while effective clinical management remains quite challenging. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some favorable benefits of modern cancer treatments in cancer‐related survival, regardless of the oncologic prognosis. This review focuses on identifying critical research‐practice gaps, addressing real‐world challenges and pinpointing real‐time insights in general terms under the context of clinical cardiotoxicity induced by the fourth and fifth modalities of cancer treatment. The information ranges from basic science to clinical management in the field of cardio‐oncology and crosses the interface between oncology and onco‐pharmacology. The complexity of the ongoing clinical problem is addressed at different levels. A better understanding of these research‐practice gaps may advance research initiatives on the development of mechanism‐based diagnoses and treatments for the effective clinical management of cardiotoxicity.

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Macrophage activation syndrome: A new complication of checkpoint inhibitors

Cited by 31 publications

References 5 publications

Hematologic Complications of Immune Checkpoint Inhibitors

Hematologic Complications of Immune Checkpoint Inhibitors

Clinical diagnosis and treatment recommendations for immune checkpoint inhibitor‐related hematological adverse events

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps, challenges, and insights

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