派安普利单抗和信迪利单抗致血栓性血小板减少性紫癜  

Thrombotic thrombocytopenic purpura induced by penpulimab and sintilimab

作　　者：张丽娜[1] 王泉[1] 高健[1] 方薇 高娜[1] 李进峰 Zhang Li'na;Wang Quan;Gao Jian;Fang Wei;Gao Na;Li Jinfeng(Department of Pharmacy,Weihai Municipal Hospital,Shandong University,Shandong Province,Weihai 264299,China)

机构地区：[1]山东大学附属威海市立医院药剂科,威海264299

出　　处：《药物不良反应杂志》2025年第3期190-192,共3页Adverse Drug Reactions Journal

基　　金：山东省药品不良反应监测中心项目(2023SDADRKY18);山东省医药卫生科技发展计划(202103050916)。

摘　　要：1例52岁男性霍奇金淋巴瘤复发患者,予6个周期吉西他滨+奥沙利铂+信迪利单抗联合治疗、15个周期信迪利单抗单药治疗后,病情进展,改用地西他滨(10 mg静脉滴注、第1~5天)+派安普利单抗(200 mg静脉滴注、第8天)治疗,21 d为1个周期。第10个周期末次给药后第5天,患者出现头痛、食欲差等不适;第7天晨起突发意识不清、晕厥。患者体温38.1℃,全身皮肤黏膜轻度黄染。实验室检查示血小板计数9×10^(9)/L,红细胞计数4.1×10^(12)/L,血红蛋白113 g/L,凝血酶原时间15.6 s,血肌酐101.6μmol/L,总胆红素61.1μmol/L,肌酸激酶同工酶43 U/L。根据实验室及影像学检查结果,考虑患者为免疫检查点抑制剂致获得性血栓性血小板减少性紫癜。予3次血浆置换,甲泼尼龙80 mg静脉滴注、1次/d等治疗5 d后,患者全身皮肤及黏膜黄染消退,糖皮质激素逐渐减量。2个月后,患者血小板计数、总胆红素等实验室检查指标恢复正常。A 52-year-old male patient with recurrent Hodgkin′s lymphoma was treated with a combination therapy of gemcitabine,oxaliplatin,and sintilimab for 6 cycles,and sintilimab monotherapy for 15 cycles.Because of disease progression,the therapy was switched to decitabine(10 mg intravenous infusion on day 1-5)and penpulimab(200 mg intravenous infusion on day 8),with 21 days as one cycle.On the 5th day after the last administration of the 10th cycle,the patient experienced discomfort such as headache and poor appetite;on the 7th day,he suddenly developed unconscious and faint.The patient had a body temperature of 38.1℃and mild yellowish skin and mucous membranes throughout the body.Laboratory tests showed platelet count 9×10^(9)/L,red blood cell count 4.1×10^(12)/L,hemoglobin 113 g/L,prothrombin time 15.6 s,blood creatinine 101.6μmol/L,total bilirubin 61.1μmol/L,and creatine kinase isoenzyme 43 U/L.Based on laboratory and imaging examinations,immune checkpoint inhibitors causing acquired thrombotic thrombocytopenic purpura was considered.The patient underwent 3 times of plasma exchanges,and received intravenous infusion of methylprednisolone 80 mg once daily and other symptomatic treatments for 5 days.The patient′s yellowish skin and mucous membranes throughout the body disappeared.The glucocorticoid was decreased gradually.Two months later,the patient′s laboratory test indicators such as platelet count and total bilirubin returned to normal.

关 键 词：紫癜 血栓性血小板减少性 派安普利单抗 信迪利单抗 免疫检查点抑制剂 

分 类 号：R733.1[医药卫生—肿瘤]