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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

4014 - Cerebrospinal fluid lymphocytosis: a hallmark of neurological immune related adverse events (irAEs) during checkpoint inhibitor treatment

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Topics

Immunotherapy;  Supportive Care and Symptom Management

Tumour Site

Presenters

Karijn Suijkerbuijk

Citation

Annals of Oncology (2018) 29 (suppl_8): viii400-viii441. 10.1093/annonc/mdy288

Authors

K.P. Suijkerbuijk1, F.Y.F.L. De Vos2, J.J. Koldenhof2, T.J. Snijders3

Author affiliations

  • 1 Medical Oncology, University Medical Center Utrecht, 3508 GA - Utrecht/NL
  • 2 Medical Oncology, University Medical Center Utrecht Cancer Center, 3508 GA - Utrecht/NL
  • 3 Brain Center Rudolf Magnus, Department Of Neurology & Neurosurgery, University Medical Center Utrecht, 3508 GA - Utrecht/NL
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Resources

Abstract 4014

Background

Checkpoint inhibitors have reshaped the oncology landscape, but their success comes at the price of immune related adverse events (irAEs). Although rare, neurological irAEs are often disabling and in some cases fatal.

Methods

We analyzed the clinical data of all patients who were treated with checkpoint inhibitors and were subsequently diagnosed with neurological irAEs in our institute since January 2015. Alternative diagnoses such as progressive disease and infectious causes were ruled out by MRI and cerebrospinal fluid (CSF) cytology and PCR.

Results

Neurological irAEs were diagnosed in six patients. All patients received anti- PD1, in two cases combined with ipilimumab. Three patients were diagnosed with aseptic meningitis, two with encephalitis and one patient with radiculitis. In all cases, there was a remarkable cerebrospinal fluid (CSF) lymphocytosis (70-99%). All six patients were treated with high-dose steroids. Subsequent intravenous immunoglobulins were administered in three patients. All patients experienced improvement of neurological symptoms after immunosuppressive treatment, with complete resolution of symptoms in three patients.

Conclusions

These data illustrate that CSF lymphocytosis is a hallmark of neurological checkpoint inhibitor toxicity and can be used as a diagnostic aid. Since lymphocytic pleiocytosis is not pathognomonic for neurological irAEs, alternative explanations for lymphocytic pleiocytosis such as viral infections should be ruled out. We encourage clinicians to assess leukocyte differentiation in patients with neurological symptoms that are treated with immune checkpoint inhibitors.

Clinical trial identification

Legal entity responsible for the study

University Medical Center Utrecht.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

K.P. Suijkerbuijk: Consulting, Advisory: Bristol-Myers Squibb, MSD; Honoraria (institution): Novartis, Roche. F.Y.F.L. De Vos: AbbVie, BioClin, Novartis. All other authors have declared no conflicts of interest.

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