Shotaro Hashimoto, Nanase Haga, Masato Morimoto, Yukiko Doi
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引用次数: 0
摘要
一名 74 岁的男子在胸部 X 光片上发现左肺完全无气。他在 58 岁时曾因腺癌接受过左下叶切除术。支气管镜检查发现,左上肺叶分支入口附近的肿瘤阻塞了管腔,活检证实了腺癌的诊断。患者接受了左侧完整肺切除术,但4L号和10号淋巴结未能完全切除。肿瘤比例评分(TPS)为15%,PD-L1(Programmed cell death 1-ligand 1)呈阳性,因此术后约1个半月开始接受pembrolizumab+培美曲塞+卡铂化疗。全血细胞减少症从第七个疗程开始出现,停止化疗后仍不见好转,于是我们请血液科医生会诊。通过骨髓活检,他被诊断为再生障碍性贫血。再生障碍性贫血对治疗无反应,无法恢复化疗。他死于肺癌恶化。
[Adenocarcinoma with Aplastic Anemia as an Immune-related Adverse Event Caused by Pembrolizumab: Report of a Case].
A 74-year-old man was found a left completely atelectasis on chest X-ray. He had undergone left lower lobe resection because of an adenocarcinoma at the age of 58. Bronchoscopy revealed a tumor near the left upper lobe branch entry that obstructed the lumen, and a biopsy confirmed the diagnosis of adenocarcinoma. A left completion pneumonectomy was performed, but #4L and #10 lymph nodes could not be completely resected. Programmed cell death 1-ligand 1( PD-L1) was positive with tumor proportion score (TPS) 15%, so chemotherapy with pembrolizumab+pemetrexed+carboplatin was started about 1.5 months after surgery. Pancytopenia appeared from the seventh course and did not improve after discontinuation of chemotherapy, so we consulted to the hematologist. He was diagnosed as aplastic anemia by bone marrow biopsy. Aplastic anemia was unresponsive to treatment and chemotherapy could not be resumed. He died of exacerbation of lung cancer.