Pembrolizumab-induced Hemophagocytic Lymphohistiocytosis: an immunotherapeutic challenge.
Publication/Presentation Date
1-1-2020
Abstract
BACKGROUND: As the number of indicated malignancies for which immune checkpoint inhibitor therapy such as pembrolizumab grows the descriptions of associated immune-related adverse events (irAEs) increases as well. On rare occasions immunotherapy can lead to development of Hemophagocytic Lymphohistiocytosis (HLH) which is a potentially lethal inflammatory disorder characterized by histiocyte activation and cytokine storm. At this time no cases of HLH developing in head and neck squamous cell carcinoma (HNSCC) patients receiving pembrolizumab have been reported.
CASE PRESENTATION: Here we describe the first documented case of pembrolizumab-induced HLH in a 61 year-old male with metastatic HNSCC after having received multiple prior cycles of pembrolizumab without event. Following cycle 14 the patient developed fever associated with new pancytopenia and transaminitis prompting hospital admission. Infectious workup was negative, his metastatic lesions were found to be stable, and there was no evidence of new malignancy. Further workup demonstrated hyperferritinemia and bone marrow biopsy demonstrated hemophagocytosis concerning for pembrolizumab-induced HLH. Etoposide and dexamethasone therapy was initiated leading to clinical improvement and safe discharge.
CONCLUSIONS: Immunotherapy is a groundbreaking therapeutic intervention for patients with malignancy, however by nature of their mechanism carry a risk of inflammatory side effects. In rare circumstances these inflammatory reactions include potentially deadly syndromes such as HLH. As immunotherapeutics such as pembrolizumab become more widely utilized increased awareness of complications such as HLH is clinically relevant.
Volume
5
First Page
3
Last Page
3
ISSN
2059-7347
Published In/Presented At
Kalmuk, J., Puchalla, J., Feng, G., Giri, A., & Kaczmar, J. (2020). Pembrolizumab-induced Hemophagocytic Lymphohistiocytosis: an immunotherapeutic challenge. Cancers of the head & neck, 5, 3. https://doi.org/10.1186/s41199-020-0050-3
Disciplines
Medicine and Health Sciences
PubMedID
32025343
Department(s)
Department of Pathology and Laboratory Medicine
Document Type
Article