信迪利单抗相关嗜血细胞综合征1例  

Sintilimab-related haemophilic syndrome:a case report

作　　者：孙志猛 段曼[1] 闻超 李娟[2] 唐晓霞[1] SUN Zhimeng;DUAN Man;WEN Chao;LI Juan;TANG Xiaoxia(Department of Pharmacy,Xiaogan Central Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432000,Hubei Province,China;Department of Pharmacy,Hubei Cancer Hospital,Wuhan 432000,China)

机构地区：[1]武汉科技大学附属孝感市中心医院药学部,湖北孝感432000 [2]湖北省肿瘤医院药学部,武汉430000

出　　处：《药物流行病学杂志》2024年第5期595-600,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：1例64岁女性患者,因经典霍奇金淋巴瘤接受信迪利单抗免疫治疗,7个周期后患者出现发热、乏力、纳差等症状,入院后辅助检查示:血红蛋白、血小板、白细胞、纤维蛋白原下降,肝酶升高,血清铁蛋白显著上升(3 727.56μg·L^(-1)),脾脏肿大,考虑为信迪利单抗相关嗜血细胞综合征。给予甲泼尼龙琥珀酸钠60 mg·d^(-1)静脉滴注2 d,40 mg·d^(-1)静脉滴注4 d,30 mg·d^(-1)静脉滴注1 d,患者症状明显好转,且体温、血象、氨基转移酶等指标逐渐恢复正常,出院后序贯为泼尼松30 mg·d^(-1)口服治疗,每周减量10 mg,直至停药。患者出院后未再重启信迪利单抗,后续随访血清铁蛋白逐渐恢复正常水平,并再未出现嗜血细胞综合征相关症状。该病例提示使用免疫检查点抑制剂期间,患者出现不明原因发热以及血象下降,且抗感染治疗无好转,应考虑嗜血细胞综合征的可能,并尽早完善血清铁蛋白等相关诊断检查,开启糖皮质激素治疗,以免延误病情。A 64-year-old woman was treated with Sindillizumab immunotherapy for classic Hodgkin lymphoma.After 7 cycles,the patient developed fever,fatigue,poor appetite,and other symptoms.Auxiliary examination after admission showed that hemoglobin,platelets,white blood cells,and fibrinogen decreased,liver enzymes increased,serum ferritin increased significantly(3727.56μg·L^(-1)),and spleen enlargement,which was finally considered to be sindilizumab associated hemophagic cell syndrome.The patient was given methylprednisolone sodium succinate 60 mg·d^(-1) intravenously for 2 days,40 mg·d^(-1) intravenously for 4 days,and 30 mg·d^(-1) intravenously for 1 day,and their symptoms improved significantly,and the temperature,blood count,aminotransferase and other indicators gradually returned to normal.After discharge,she was changed to prednisone 30 mg·d^(-1) oral therapy,and the dose was reduced https://ywlxbx.whuznhmedj.com/by 10 mg per week until withdrawal.The patient did not restart sindilizumab after discharge,and the serum ferritin gradually returned to normal level during follow-up,and no hemophagocytic syndrome-related symptoms appeared again.It was suggested that during the use of immune checkpoint inhibitors,patients with unexplained fever and decreased blood counts,in the absence of improvement in anti-infection,the possibility of hemophagocytic syndrome should be considered and relevant diagnostic tests such as serum ferritin should be improved as soon as possible,and glucocorticoid therapy should be turned on to avoid delay of the disease.

关 键 词：信迪利单抗 嗜血细胞综合征 血清铁蛋白 药品不良反应 

分 类 号：R969[医药卫生—药理学]