Severe meningo-radiculo-nevritis associated with ipilimumab

Bompaire, Flavie; Mateus, Christine; Taillia, H.; Greslan, T. De; Lahutte, M.; Sallansonnet-Froment, M.; Ouologuem, M.; Renard, Jean-Luc; Gorochov, Guy; Robert, Caroline; Ricard, Damien

doi:10.1007/s10637-011-9787-1

Cited by 64 publications

(43 citation statements)

References 17 publications

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“…On the other hand, immune-related neuropathy is another possible cause of atonic neurogenic bladder, as reported previously in several cases of radiculoneuropathy induced by ipilimumab [19][20][21].…”

Section: Discussionsupporting

confidence: 56%

Colitis mimicking graft-versus-host disease during treatment with the anti-CCR4 monoclonal antibody, mogamulizumab

et al. 2015

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A 57-year-old male with acute-type adult T cell leukemia-lymphoma (ATL) developed persistent watery, non-bloody diarrhea at a volume of 2-3 L/day following the administration of the anti-CC chemokine receptor 4 (CCR4) monoclonal antibody, mogamulizumab. An extensive examination revealed the absence of any pathogenic bacteria or parasites in his stool. Biopsied specimens from the colonic mucosa contained many small nests of apoptotic bodies in the colonic glands, which mimicked acute-colonic graft-versus-host disease. Activation of the auto-reactive immune system due to the depletion of regulatory T-cells by mogamulizumab was suspected as causative. Special attention should be paid to the risk of unique immune-related adverse events induced by mogamulizumab.

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Section: Discussionsupporting

confidence: 56%

Colitis mimicking graft-versus-host disease during treatment with the anti-CCR4 monoclonal antibody, mogamulizumab

et al. 2015

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“…The same applies to hypophysitis and immune-related meningitis, as T lymphocytes are important in the pathogenesis of these illnesses 10 11. There have been only two reported cases of Guillain–Barré syndrome during ipilimumab treatment so far 12 13. In retrospect, we would have treated our patient with prednisolone in addition to intravenous immunoglobulin.…”

Section: Discussionmentioning

confidence: 88%

Neurological immune-related adverse events of ipilimumab

et al. 2013

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Ipilimumab enhances the T lymphocyte mediated immune response to both tumour cells and healthy tissue, improving survival in patients with metastatic melanoma but also leads to more immune-related adverse events (irAEs) than previously used treatments, such as dacarbazine. We present three patients with neurological irAEs from ipilimumab treatment: hypophysitis, meningitis and Guillain-Barré syndrome. Once an irAE occurs, ipilimumab should be stopped and corticosteroids started. Usually, ipilimumab-induced irAE symptoms improve within days to weeks, but can be life-threatening if unrecognised.

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“…Ipilimumab-associated neurological irAEs span diverse entities including severe meningo-radiculo-neuritis [18], reversible splenial lesions [19, 20], hypophysitis [21], meningitis [21], acute cerebellitis [22], Guillain-Barre syndrome [21, 23], myasthenia gravis [24–27], bilateral phrenic nerve paralysis [28], Bell’s palsy [28], chronic inflammatory demyelinating polyneuropathy (CIDP) [29], transverse myelitis [29], encephalitis [30], necrotic myelopathy [31], and partial motor convulsive status (epilepsia partialis continua) [32]. Herein, we report two cases of ipilimumab-associated neurological irAEs manifesting as meningoencephalomyelitis and AIDP respectively.…”

Section: Discussionmentioning

confidence: 99%

Neurologic immune-related adverse events associated with adjuvant ipilimumab: report of two cases

Garcia¹,

El-Ali²,

Rath³

et al. 2018

j. immunotherapy cancer

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BackgroundPD-1 and CTLA-4 inhibitors are associated with several adverse events including a spectrum of immune-related adverse effects (irAEs). Neurologic irAEs are uncommon occurrences with varied presentations. We describe two separate cases of ipilimumab associated meningoencephalomyelitis and demyelinating polyneuropathy with unusual presentations.Case presentationTwo melanoma patients were treated with ipilimumab in the adjuvant setting. The first patient developed a meningoencephalitis following 3 doses of ipilimumab. MRI imaging of the brain confirmed leptomeningeal enhancement although cerebrospinal fluid (CSF) analyses were negative for malignant cells consistent with meningoencephalomyelitis. Although she initially improved following treatment with steroids and intravenous immunoglobulin, she subsequently relapsed. She was successfully treated with infliximab and made a complete neurological recovery. A second patient developed progressive lower extremity weakness following two doses of ipilimumab. MRI imaging of the spine confirmed diffuse nerve root enhancement consistent with acute inflammatory demyelinating polyneuropathy (AIDP). He was treated with high dose steroids with resolution of neurological symptoms. Both patients remain disease free.ConclusionsNeurological irAEs are uncommon adverse events in the context of CTLA-4 and/or PD-1 inhibitor therapy. Care must be taken to distinguish these from leptomeningeal disease. Early recognition of neurological irAEs is critical for the initiation of specific anti-inflammatory agents to prevent and potentially reverse neurological sequelae.

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Severe meningo-radiculo-nevritis associated with ipilimumab

Abstract: The adverse event profile associated with ipilimumab was primarily immune-related. This is the first case in which such a severe event has been reported.

Cited by 64 publications

References 17 publications

Colitis mimicking graft-versus-host disease during treatment with the anti-CCR4 monoclonal antibody, mogamulizumab

Colitis mimicking graft-versus-host disease during treatment with the anti-CCR4 monoclonal antibody, mogamulizumab

Neurological immune-related adverse events of ipilimumab

Neurologic immune-related adverse events associated with adjuvant ipilimumab: report of two cases

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