B cell-driven refractory hemocytopenia in immune checkpoint inhibitor therapy: a report of two cases.

IF 3.5 2区医学 Q2 ONCOLOGY

Translational lung cancer research Pub Date : 2026-03-23 Epub Date: 2026-02-26 DOI:10.21037/tlcr-2025-939

Feng Li, Chunyan Wang, Guohua Yao, Shaotong Zhang, Qian Hu, Zhenyu Ju, Wenhua Liang

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引用次数: 0

Abstract

Background: The integration of immune checkpoint inhibitors (ICIs) with chemotherapy has revolutionized lung cancer treatment, yet it amplifies the risk of severe hematologic toxicities.

Case description: We describe two patients with advanced lung cancer who developed life-threatening refractory hemocytopenia following ICIs-chemotherapy, unresponsive to glucocorticoids and hematopoietic growth factors. A striking feature of these cases was the exclusive presence of anti-Sjögren's-syndrome-related antigen A (Ro) (SSA) antibodies in refractory patients, but absent in non-refractory controls. Targeted administration of intravenous immunoglobulin (IVIG) and rituximab was temporally associated with clearance of anti-SSA antibodies and restoration of normal hematopoiesis, raising the hypothesis that aberrant B cell activity may contribute to refractory hemocytopenia in this setting.

Conclusions: These observations suggest that anti-SSA antibodies could represent a candidate biomarker for identifying refractory hemocytopenia in early time. These findings support a proposal for routine anti-SSA screening in ICI-related hematologic toxicity to enable timely B cell-targeted management.

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免疫检查点抑制剂治疗中B细胞驱动的难治性血细胞减少：附2例报告。

背景：免疫检查点抑制剂（ICIs）与化疗的结合已经彻底改变了肺癌的治疗，但它增加了严重血液毒性的风险。病例描述：我们描述了两例晚期肺癌患者，他们在icis化疗后出现危及生命的难治性血细胞减少症，对糖皮质激素和造血生长因子无反应。这些病例的一个显著特征是在难治性患者中只存在anti-Sjögren综合征相关抗原A (Ro) （SSA）抗体，而在非难治性对照组中不存在。靶向静脉注射免疫球蛋白（IVIG）和利妥昔单抗与抗ssa抗体的清除和正常造血功能的恢复暂时相关，这提出了异常B细胞活性可能导致这种情况下难治性血细胞减少的假设。结论：这些观察结果表明抗ssa抗体可以作为早期识别难治性血细胞减少症的候选生物标志物。这些发现支持在ici相关血液学毒性中进行常规抗ssa筛查的建议，以便及时进行B细胞靶向治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational lung cancer research Medicine-Oncology

CiteScore

7.20

自引率

2.50%

发文量

137

期刊介绍： Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.