Title |
Cardiac allograft rejection as a complication of PD-1 checkpoint blockade for cancer immunotherapy: a case report
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Published in |
Cancer Immunology, Immunotherapy, October 2016
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DOI | 10.1007/s00262-016-1918-2 |
Pubmed ID | |
Authors |
Taofeek K. Owonikoko, Mukesh Kumar, Shu Yang, Alice O. Kamphorst, Rathi N. Pillai, Rama Akondy, Vivek Nautiyal, Monica S. Chatwal, Wendy M. Book, Anurag Sahu, Gabriel L. Sica, Rafi Ahmed, Suresh S. Ramalingam |
Abstract |
The increased availability of immunotherapeutic agents for the treatment of a wide array of cancer in the general oncology practice setting will reveal rare and unique toxicities. The mechanism of cardiac allograft rejection in the context of PD-1 antibody therapy was explored in a patient with cutaneous squamous cell cancer complicating long-standing cardiac allograft. Immune cell infiltrate in the myocardium and peripheral blood lymphocyte repertoire were assessed using myocardial biopsy and temporal analysis of peripheral blood samples. The efficacy of high-intensity immunosuppression to reverse graft rejection was explored. Endomyocardial biopsy showed acute moderate diffuse cellular rejection with a predominant population of CD3+, CD8+ and CD4+ infiltrating lymphocytes; peripheral blood circulating lymphocytes showed a high frequency of proliferating and activated CD8+ T cells expressing PD-1 compared to a normal control. There was no difference in the activation and proliferation of CD4+ T cells compared to a normal control. Cardiac function improved following high-intensity immunosuppression and patient survived for up to 7 months after discontinuation of nivolumab. Immune checkpoint inhibitors should be avoided in allograft recipients but high-intensity immunosuppression is effective to salvage allograft rejection induced by these agents. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Unknown | 2 | 100% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 1 | 50% |
Practitioners (doctors, other healthcare professionals) | 1 | 50% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Egypt | 1 | 2% |
Unknown | 51 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 7 | 13% |
Unspecified | 6 | 12% |
Researcher | 6 | 12% |
Student > Doctoral Student | 4 | 8% |
Student > Ph. D. Student | 4 | 8% |
Other | 13 | 25% |
Unknown | 12 | 23% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 21 | 40% |
Unspecified | 6 | 12% |
Immunology and Microbiology | 4 | 8% |
Biochemistry, Genetics and Molecular Biology | 3 | 6% |
Nursing and Health Professions | 2 | 4% |
Other | 2 | 4% |
Unknown | 14 | 27% |