Thrombotic thrombocytopenic purpura(TTP)is a rare and life-threatening form of thrombotic microangiopathy,primarily caused by a deficiency of ADAMTS-13 activity.Immune-related adverse events(irAEs)are autoimmune toxic...Thrombotic thrombocytopenic purpura(TTP)is a rare and life-threatening form of thrombotic microangiopathy,primarily caused by a deficiency of ADAMTS-13 activity.Immune-related adverse events(irAEs)are autoimmune toxicities mediated by the use of immune checkpoint inhibitors(ICIs).Here,the study reports a case of thrombotic thrombocytopenic purpura that developed in a patient with renal cell carcinoma and vertebral metastasis following combined treatment with Toripalimab and Pazopanib.The patient received Toripalimab in combination with Pazopanib after undergoing radical nephrectomy for right renal cell carcinoma.Five days later,a generalized erythematous rash appeared,partly confluent,accompanied by congestion and swelling of both palpebral and bulbar conjunctiva.Based on the clinical presentation and laboratory results showing thrombocytopenia and hemolytic anemia,the diagnosis of TTP was established.The condition was considered an adverse effect associated with the combination therapy of Toripalimab and Pazopanib.Plasma exchange and high-dose intravenous immunoglobulin therapy were promptly initiated.The treatment regimen was subsequently modified to Axitinib combined with radiotherapy,leading to a gradual recovery of platelet counts.This report highlights the potential risk of TTP associated with combined ICI and TKI therapy,and underscores the importance of early recognition and timely management of this potentially fatal complication.展开更多
近年来,肿瘤免疫治疗成为研究热点,PD-1(Programmed cell death 1)及其配体1PD-L1(PD-1ligand)抑制剂因其特异性强、副作用低、肿瘤控制时间长等优点,在肿瘤治疗的临床应用中取得了振奋人心的成果。然而,随着PD-1/PD-L1抑制剂的推广与运...近年来,肿瘤免疫治疗成为研究热点,PD-1(Programmed cell death 1)及其配体1PD-L1(PD-1ligand)抑制剂因其特异性强、副作用低、肿瘤控制时间长等优点,在肿瘤治疗的临床应用中取得了振奋人心的成果。然而,随着PD-1/PD-L1抑制剂的推广与运用,其引起的免疫相关不良反应(Immune related adverseevents,IrAEs)亦带来了新挑战,如何预防及减轻IrAEs、使免疫抑制剂发挥更好的治疗作用已成为当今研究的重要课题。近几年中医药在防治IrAEs中发挥了较好的作用,不仅能够调节机体免疫功能及肿瘤免疫微环境,同时可以预防和减轻IrAEs,值得深入研究。展开更多
基金Natural Science Foundation of Gansu Province(Project No.:24JRRA615)Outstanding Talent Recruitment Program and the Doctoral Start-up Fund of Gansu Provincial Central Hospital(Project No.:GMCCH2024-2-6)。
文摘Thrombotic thrombocytopenic purpura(TTP)is a rare and life-threatening form of thrombotic microangiopathy,primarily caused by a deficiency of ADAMTS-13 activity.Immune-related adverse events(irAEs)are autoimmune toxicities mediated by the use of immune checkpoint inhibitors(ICIs).Here,the study reports a case of thrombotic thrombocytopenic purpura that developed in a patient with renal cell carcinoma and vertebral metastasis following combined treatment with Toripalimab and Pazopanib.The patient received Toripalimab in combination with Pazopanib after undergoing radical nephrectomy for right renal cell carcinoma.Five days later,a generalized erythematous rash appeared,partly confluent,accompanied by congestion and swelling of both palpebral and bulbar conjunctiva.Based on the clinical presentation and laboratory results showing thrombocytopenia and hemolytic anemia,the diagnosis of TTP was established.The condition was considered an adverse effect associated with the combination therapy of Toripalimab and Pazopanib.Plasma exchange and high-dose intravenous immunoglobulin therapy were promptly initiated.The treatment regimen was subsequently modified to Axitinib combined with radiotherapy,leading to a gradual recovery of platelet counts.This report highlights the potential risk of TTP associated with combined ICI and TKI therapy,and underscores the importance of early recognition and timely management of this potentially fatal complication.
文摘近年来,肿瘤免疫治疗成为研究热点,PD-1(Programmed cell death 1)及其配体1PD-L1(PD-1ligand)抑制剂因其特异性强、副作用低、肿瘤控制时间长等优点,在肿瘤治疗的临床应用中取得了振奋人心的成果。然而,随着PD-1/PD-L1抑制剂的推广与运用,其引起的免疫相关不良反应(Immune related adverseevents,IrAEs)亦带来了新挑战,如何预防及减轻IrAEs、使免疫抑制剂发挥更好的治疗作用已成为当今研究的重要课题。近几年中医药在防治IrAEs中发挥了较好的作用,不仅能够调节机体免疫功能及肿瘤免疫微环境,同时可以预防和减轻IrAEs,值得深入研究。
