Immune checkpoint inhibitor-related CNS vasculitis – A systematic review and report of 6 cases

IF 2 4区 医学 Q3 NEUROSCIENCES
Mai Erritzøe-Jervild MD , Simon Nue Møller MD , Christina Kruuse MD, PhD (Professor) , Christian Stenør MD (associate Professor)
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引用次数: 0

Abstract

Background

Immune checkpoint inhibitors (ICI) represent an important new class of immunotherapy used in cancer treatment. Though effective, immune-related adverse events (irAE) are reported, including cerebral vasculitis (nirVasculitis). In this systematic review, we aim to identify clinical and laboratory features of nirVasculitis and exemplify these in six local clinical cases.

Observations

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent researchers searched, identified, and extracted data from both PubMed and Embase to identify reports on nirVasculitis. Based on current criteria for diagnostic certainty patients were categorized as having definite, probable, or possible nirVasculitis. 20 cases described relevant symptomatology and met our inclusion criteria. Non-small-cell lung cancer (55 %) was the most frequent cancer type. Most cases (95 %) received a programmed death-1 (PD-1) inhibitor. One patient had definite vasculitis, seven probable vasculitis, and twelve possible vasculitis. Signs and symptoms included aphasia (n = 5), loss of consciousness (n = 7), confusion (n = 8), unilateral sensory or motor dysfunction (n = 5), and fever or headache (n = 9). All patients had brain imaging and seventeen underwent a lumbar puncture. Of these, 64.7 % had pleocytosis and 52.9 % elevated protein in cerebrospinal fluid. Nineteen patients received corticosteroids. Eight patients fully or partially recovered. Eight patients died due to nirVasculitis, three to advanced cancer, and one lost to follow-up.

Conclusions

There are few clinical reports of nirVasculitis which may be due to underreporting or rarity of complications. Guidelines for diagnostics and reporting may improve awareness and early recognition to initiate important immunosuppressive treatment.
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来源期刊
CiteScore
5.00
自引率
4.00%
发文量
583
审稿时长
62 days
期刊介绍: The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.
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