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1.
Rinsho Ketsueki ; 63(4): 260-264, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35491214

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by hemolysis, thrombosis, and bone marrow failure. Infection, pregnancy, and surgical operation have the potential to evoke severe episodes of hemolysis and thrombosis. Therefore, the use of an antibody agent against complement component 5 (C5), eculizumab, one day before the operation is recommended. Ravulizumab is a newly approved long-acting antibody agent against C5. Thus, little is known about perioperative management with ravulizumab. We experienced a 43-year-old female patient who safely underwent laparoscopic cholecystectomy under ravulizumab treatment for PNH. Ravulizumab was administered one day before the operation. Laparoscopic cholecystectomy for cholelithiasis was performed under intravenous anesthesia, intermittent air compression of the lower extremities, and low pneumoperitoneum pressure. Additionally, heparin was administered, and the patient left the sickbed early without significant postoperative complications. Like eculizumab, complement inhibition by ravulizumab is also considered effective in the perioperative management of patients with PNH. However, close cooperation with surgeons and anesthesiologists and careful management based on clinical symptoms and laboratory data such as LDH, CH50, and D-dimer are essential.


Assuntos
Colecistectomia Laparoscópica , Hemoglobinúria Paroxística , Trombose , Adulto , Anticorpos Monoclonais Humanizados , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/tratamento farmacológico , Hemólise , Humanos , Gravidez , Trombose/etiologia
2.
In Vivo ; 35(6): 3407-3411, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697176

RESUMO

BACKGROUND: Neurotoxicity is one of the dangerous complications of chimeric antigen receptor (CAR) T-cell therapy, while its pathophysiology remains to be fully understood. Motor weakness not associated with central nervous system (CNS) toxicity has rarely been reported after CAR T-cell therapy. CASE REPORT: A 42-year-old female with a refractory diffuse large B-cell lymphoma received tisagenlecleucel (tisa-cel) and developed cytokine release syndrome (CRS) on day 3. She was treated with tocilizumab and methylprednisolone, which resolved CRS promptly. On day 7, motor weakness in lower extremities appeared, and she gradually became unable to walk without showing any other symptoms attributed to CNS disturbances. Whereas dexamethasone and tocilizumab were ineffective, neuropathy improved after high dose chemotherapy followed by autologous stem cell transplantation. Nerve conduction study (NCS) in lower extremities showed a decline in compound muscle action potential amplitude along with worsening of motor weakness, which was restored after improvement of symptoms. Based on symptoms and NCS, her motor weakness was thought to be due to disturbance in peripheral nerves. CONCLUSION: This study reports a patient who developed severe motor weakness due to disturbance in peripheral nerves after tisa-cel therapy. Neurotoxicity of non-CNS origin should also be noted in CAR T-cell therapy.


Assuntos
Imunoterapia Adotiva/efeitos adversos , Debilidade Muscular/induzido quimicamente , Nervos Periféricos , Receptores de Antígenos de Linfócitos T , Adulto , Síndrome da Liberação de Citocina/induzido quimicamente , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/fisiopatologia , Transplante Autólogo
3.
Intern Med ; 59(6): 829-833, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31761888

RESUMO

Nivolumab exerts therapeutic activity in patients with classic Hodgkin's lymphoma (CHL) but may cause several types of immune-related adverse events. Some rheumatoid arthritis (RA) patients develop CHL during methotrexate therapy (MTX-CHL); however, the efficacy and safety of nivolumab for these patients remain unclear. A 68-year-old woman was diagnosed with CHL after six years of MTX therapy for RA. The disease did not respond to any type of chemotherapy. Nivolumab was then initiated, and the patient was successfully treated without the reactivation of RA. The reactivation of RA always needs to be considered with the administration of nivolumab.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Antirreumáticos/efeitos adversos , Doença de Hodgkin/induzido quimicamente , Doença de Hodgkin/tratamento farmacológico , Metotrexato/efeitos adversos , Nivolumabe/uso terapêutico , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Metotrexato/uso terapêutico
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