Pembrolizumab associated hemophagocytic lymphohistiocytosis

Shah, Darshil; Shrestha, Runa; Ramlal, Reshma; Hatton, Jimmi; Saeed, Hayder

doi:10.1093/annonc/mdx113

Cited by 46 publications

(22 citation statements)

References 4 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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“…On literature review, the case reports discussing immunotherapy-induced HLH have described a wide range of underlying malignancies including Squamous Cell Carcinoma of the Lung, Urothelial Carcinoma, Thymic Carcinoma, Merkel Cell Carcinoma, Breast Cancer, and Melanoma however to our knowledge this is the first report of immunotherapy-induced HLH in a HNSCC patient [3][4][5][6][7][8][9][10][11]. The time to HLH onset after starting immunotherapy has been shown to be highly variable, ranging from less than a month after receiving either pembrolizumab, nivolumab, or combination ipilimumab/nivolumab to over a year in a patient treated with pembrolizumab [3,4,7].…”

Section: Discussionmentioning

confidence: 95%

Pembrolizumab-induced Hemophagocytic Lymphohistiocytosis: an immunotherapeutic challenge

et al. 2020

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Background: As the number of indicated malignancies for which immune checkpoint inhibitor therapy such as pembrolizumab grows the descriptions of associated immune-related adverse events (irAEs) increases as well. On rare occasions immunotherapy can lead to development of Hemophagocytic Lymphohistiocytosis (HLH) which is a potentially lethal inflammatory disorder characterized by histiocyte activation and cytokine storm. At this time no cases of HLH developing in head and neck squamous cell carcinoma (HNSCC) patients receiving pembrolizumab have been reported. Case presentation: Here we describe the first documented case of pembrolizumab-induced HLH in a 61 year-old male with metastatic HNSCC after having received multiple prior cycles of pembrolizumab without event. Following cycle 14 the patient developed fever associated with new pancytopenia and transaminitis prompting hospital admission. Infectious workup was negative, his metastatic lesions were found to be stable, and there was no evidence of new malignancy. Further workup demonstrated hyperferritinemia and bone marrow biopsy demonstrated hemophagocytosis concerning for pembrolizumab-induced HLH. Etoposide and dexamethasone therapy was initiated leading to clinical improvement and safe discharge. Conclusions: Immunotherapy is a groundbreaking therapeutic intervention for patients with malignancy, however by nature of their mechanism carry a risk of inflammatory side effects. In rare circumstances these inflammatory reactions include potentially deadly syndromes such as HLH. As immunotherapeutics such as pembrolizumab become more widely utilized increased awareness of complications such as HLH is clinically relevant.

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“…To our knowledge, there have only been three previous reports on ICI-related HLH. Two of them involved melanoma and bladder cancer (12,13). The other one referred to a lung cancer patient on pembrolizumab without rheumatologic conditions (14).…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic Lymphohistiocytosis in a Patient with Rheumatoid Arthritis on Pembrolizumab for Lung Adenocarcinoma

et al. 2020

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Immune checkpoint inhibitors have changed the landscape of classic cancer treatment. However, their use is associated with the emergence of new adverse events. An elderly man with rheumatoid arthritis was started on pembrolizumab for newly diagnosed advanced lung cancer. He subsequently developed hemophagocytic lymphohistiocytosis (HLH), which is potentially fatal but has not been properly established as an immune checkpoint inhibition-induced event. We herein report the case of a patient with pembrolizumab-induced HLH.

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Pembrolizumab associated hemophagocytic lymphohistiocytosis

Cited by 46 publications

References 4 publications

Hematologic Complications of Immune Checkpoint Inhibitors

Hematologic Complications of Immune Checkpoint Inhibitors

Pembrolizumab-induced Hemophagocytic Lymphohistiocytosis: an immunotherapeutic challenge

Hemophagocytic Lymphohistiocytosis in a Patient with Rheumatoid Arthritis on Pembrolizumab for Lung Adenocarcinoma

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