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Vol.60 No.5 contents | Japanese/English |
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- Case Report -
Hemophagocytic Lymphohistiocytosis That Developed Soon After the Initial Administration of Atezolizumab, Which Is an Anti-PD-L1 Antibody Drug, and Thereafter Deteriorated Rapidly: an Autopsy Case
Norihiko Yamaguchi1, Aiko Miyamoto1, Kento Kuniya1, Koji Azuma1, Akio Osa1, Sho Goya1, Takashi Kusu2, Kiyonori Nishioka3, Kyo Hirayama4, Shunsuke Sakai51Department of Respiratory Medicine, 2Department of Respiratory Surgery, Kinki Central Hospital for Mutual Aids for Prefectural Teachers, Japan, 3Nishioka Medical Clinic, Japan, 4Department of Neurology Medicine, Kinki Central Hospital for Mutual Aids for Prefectural Teachers, Japan, 5Depatment of General Respiratory Center, Osaka Prefectural Habikino Medical Center, Japan
Background. In the treatment of lung cancer with immune checkpoint inhibitor (ICI), immune-related adverse events (irAEs), which are adverse effects that differ in nature from those that occur with conventional cytotoxic anti-cancer agents, may occur and can sometimes even be fatal. Hemophagocytic lymphohistiocytosis (HLH) is an infrequent irAE, but it is a significant adverse effect with the potential to become severe. Case. Atezolizumab, an anti-PD-L1 antibody, was administered during secondary chemotherapy for postoperative recurrent lung adenocarcinoma. Nine days after the initial administration, the patient developed HLH which did not respond at all to any kind of treatment. Multiple organ failure thereafter occurred, and demonstrating a superacute course the patient died only 17 days after the initial administration of atezolizumab. It is highly likely that irAE was involved in the occurrence of HLH in this course. Conclusion. Physicians should bear in mind that there is a possibility of fatal HLH occurring within a very short time after the initial administration of ICI treatment.
key words: Immune checkpoint inhibitor, Anti-PD-L1 antibody, Immune-related adverse event, Hemophagocytic lymphohistiocytosis, Initial administration
Received: April 28, 2020
Accepted: July 6, 2020
JJLC 60 (5): 423-428, 2020
