TY - JOUR
T1 - Critically ill patients with severe immune checkpoint inhibitor related neurotoxicity
T2 - A multi-center case series
AU - Rajendram, Prabalini
AU - Torbic, Heather
AU - Duggal, Abhijit
AU - Campbell, Jeannee
AU - Hovden, Michael
AU - Dhawan, Vikram
AU - Pastores, Stephen M.
AU - Gutierrez, Cristina
N1 - Funding Information:
This study was supported, in part, by the Core Grant ( P30 CA008748 ) and the Department of Anesthesiology and Critical Care Medicine , Memorial Sloan Kettering Cancer Center, New York, NY.
Funding Information:
This study was supported, in part, by the Core Grant (P30 CA008748) and the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - Purpose: Serious immune checkpoint inhibitor (ICI)-related neurotoxicity is rare. There is limited data on the specifics of care and outcomes of patients with severe neurological immune related adverse events (NirAEs) admitted to the Intensive Care Unit (ICU). Materials and methods: Retrospective study of patients with severe NirAEs admitted to the ICU at 3 academic centers between January 2016 and December 2018. Clinical data collected included ICI exposure, type of NirAE (central [CNS] or peripheral nervous system [PNS) disorders), and patient outcomes including neurological recovery and mortality. Results: Seventeen patients developed severe NirAEs. Eight patients presented with PNS disorders; 6 with myasthenia gravis (MG), 1 had a combination of MG and polyneuropathy and 1 had Guillain-Barre syndrome. Nine patients had CNS disorders (6 seizures and 5 had concomitant encephalopathy. During ICU admission, 65% of patients required mechanical ventilation, 35% vasopressors, and 18% renal replacement therapy. The median ICU and hospital length of stay were 7 (2–36) and 18 (4–80) days, respectively. Hospital mortality was 29%. At hospital discharge, 18% of patients made a full neurologic recovery, 41% partial recovery, and 12% did not recover. Conclusion: Severe NirAEs while uncommon, can be serious or even life-threatening if not diagnosed and treated early.
AB - Purpose: Serious immune checkpoint inhibitor (ICI)-related neurotoxicity is rare. There is limited data on the specifics of care and outcomes of patients with severe neurological immune related adverse events (NirAEs) admitted to the Intensive Care Unit (ICU). Materials and methods: Retrospective study of patients with severe NirAEs admitted to the ICU at 3 academic centers between January 2016 and December 2018. Clinical data collected included ICI exposure, type of NirAE (central [CNS] or peripheral nervous system [PNS) disorders), and patient outcomes including neurological recovery and mortality. Results: Seventeen patients developed severe NirAEs. Eight patients presented with PNS disorders; 6 with myasthenia gravis (MG), 1 had a combination of MG and polyneuropathy and 1 had Guillain-Barre syndrome. Nine patients had CNS disorders (6 seizures and 5 had concomitant encephalopathy. During ICU admission, 65% of patients required mechanical ventilation, 35% vasopressors, and 18% renal replacement therapy. The median ICU and hospital length of stay were 7 (2–36) and 18 (4–80) days, respectively. Hospital mortality was 29%. At hospital discharge, 18% of patients made a full neurologic recovery, 41% partial recovery, and 12% did not recover. Conclusion: Severe NirAEs while uncommon, can be serious or even life-threatening if not diagnosed and treated early.
KW - CTLA-4
KW - Immune checkpoint inhibitors
KW - Immune related adverse events
KW - Intensive care unit
KW - Neurotoxicity
KW - PD-1/PD-L1
UR - http://www.scopus.com/inward/record.url?scp=85107978029&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85107978029&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2021.05.020
DO - 10.1016/j.jcrc.2021.05.020
M3 - Article
C2 - 34139658
AN - SCOPUS:85107978029
SN - 0883-9441
VL - 65
SP - 126
EP - 132
JO - Journal of critical care
JF - Journal of critical care
ER -