Formation of necrotizing vasculitis in the patient with diffuse B-cell large cell lymphoma on immune checkpoint inhibitor (PD-1) therapy

Abstract

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have significantly improved the prognosis and clinical outcomes for patients with malignancies in many types of cancer. Nivolumab is a human monoclonal antibody that blocks the interaction between PD-1 and PD-L1/2, thereby preventing inhibition of T-cells, which contributes to the antitumor response. The use of ICT can lead to autoimmune aggression and the development of adverse events. Most of these are eliminated on their own after ICT therapy and steroid treatment have been discontinued.

CLINICAL CASE DESCRIPTION: A 73-year-old patient with recurrent large B-cell lymphoma, on the background of R-CHOP, R-CHOP-mini, R-GDOx therapy incomplete clinical effect and frequent relapses have been registered. On immunohistochemistry, PD-L1 was positive in 90 % of the tumor cells. A decision has been made to administer the checkpoint inhibitor (PD-1) nivolumab, which developed a necrotizing vasculitis after three injections.

CONCLUSION: On temporary withdrawal of the drug and administration of prednisolone at a dose of 1 mg/kg/day, the skin has recovered completely. When the PD-1 inhibitor was reapplied, there was no recurrence of autoimmune aggression. The treatment has been continued in the full way.

Keywords

immune checkpoint inhibitors / nivolumab / PD-1 / PD-L1/2 / Diffuse B-cell large cell lymphoma / necrotizing vasculitis / immunohistochemistry

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Mazurov V.I., Melnikov E.S., Pavlyuchenko E.S., Dyakonova M.N.