1例帕博利珠单抗致持续4级血小板减少症的病例分析

A case analysis of pembrolizumab-induced persistent grade 4 thrombocytopenia

目的探讨帕博利珠单抗致持续严重血小板减少症的临床特征和治疗方案。方法以1例帕博利珠单抗致持续4级血小板减少症的病例分析为切入点,查阅文献,分析其临床特征及治疗方案。结果数据显示帕博利珠单抗引起严重血小板减少的发生率很低,部分患者经糖皮质激素、环孢素等免疫抑制治疗效果不佳,其原因可能与反复使用程序性死亡受体1(PD-1)抑制剂后体内“免疫刹车”失灵导致自身免疫异常有关。结论临床医生应权衡利弊,密切监测患者血小板计数,保障患者用药安全。

Objective To explore the clinical feature and treatment of pembrolizumab-induced persistent severe throm-bocytopenia.Methods Taking a case of pembrolizumab-induced persistent grade 4 thrombocytopenia as an entry point,the clinical characteristics and treatment plan were analyzed by reviewing the literature.Results The data showed that the inci-dence was very low of severe thrombocytopenia caused by pembrolizumab.Some patients had poor effect after immunosup-pressive therapy such as glucocorticoid and cyclosporine.The reason may be related to the autoimmune abnormalities re-sulted by the failure of"immune brake"in vivo after repeated use of programmed death-1(PD-1)inhibitors.Conclusion Clinicians should weigh up the pros and cons,and closely monitor platelet counts,so as to ensure the medication safety of patients.