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Velev M, Baroudjian B, Pruvost R, De Martin E, Laparra A, Babai S, Teysseire S, Danlos FX, Albiges L, Bernigaud C, Benderra MA, Pradère P, Zaidan M, Decroisette C, Fallah F, Matergia G, Lavaud P, Jantzem H, Atzenhoffer M, Buyse V, Ammari S, Robert C, Champiat S, Messayke S, Marabelle A, Guettier C, Lebbe C, Lambotte O, Michot JM. Immune-related generalised oedema - A new category of adverse events with immune checkpoint inhibitors. Eur J Cancer 2023; 179:28-47. [PMID: 36473326 DOI: 10.1016/j.ejca.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Generalised oedema was occasionally reported associated with immune checkpoint inhibitors (ICPIs). The purpose of this study is to investigate immune-related generalised oedema (ir-GE) drug related to ICPI, through frequency, clinical and pathological characteristics, and patient's outcome. PATIENTS AND METHODS Objectives of the study were to report on ir-GE associated with ICPI to define frequency, associated signs and symptoms, pathological characteristics, severity, and response to corticosteroids. To be included in the study, adult patients had to have ir-GE related to ICPI with certain or likely link, without any other known causes of generalised oedema. The study design was observational, over the period 2014-2020, from pharmacovigilance databases in France, including the prospective Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC) registry. Calculation of the frequency of ir-GE was restricted to the prospective REISAMIC registry. RESULTS Over 6633 screened patients, 20 had ir-GE confirmed drug related to ICPI. Based on the prospective REISAMIC registry, the frequency of ir-GE was 0.19% of ICPI-treated patients (3 cases out of 1598 screened patients). The 20 patients with ir-GE had a median (range) age of 62 (26-81) years, most frequent tumour types were melanoma (n = 9; 45%) and lung cancer (n = 6; 30%). The most frequent localisations of oedema were peripheral (n = 17; 85%), pleural (n = 13; 65%), and peritoneal (n = 10; 50%). Polyserositis was observed in 11 (55%) patients. The median (range) weight gain per patient was 9 (2-30) kg. Associated signs and symptoms met criteria for capillary leak syndrome (n = 4; 20%), sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) (n = 3; 15%), or subcutaneous autoimmune syndrome (n = 2; 10%). Corticosteroids were administered to 15 patients; of them, 10 (67%) improved clinically after corticosteroids. Based on CTCAEV5.0, the highest severity of ir-GE was grade ≥4 in 11 (55%) patients and four (20%) patients died due to ir-GE. CONCLUSIONS Generalised immune system-related oedema is a new category of adverse event with immune checkpoint inhibitors and is often associated with a life-threatening condition. The pathophysiology may in some cases be related to endothelial dysfunctions, such as SOS/VOD or capillary leak syndrome.
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Affiliation(s)
- Maud Velev
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Barouyr Baroudjian
- Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, Dermatology Department, 75010 Paris, France
| | - Roxane Pruvost
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Eleonora De Martin
- Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Department of Hepatology, Centre Hépato-Biliaire, INSERM 1193, 94800 Villejuif, France
| | - Ariane Laparra
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Samy Babai
- Assistance Publique - Hôpitaux de Paris, Henri Mondor Hospital, Department of Pharmacovigilance, 94000 Créteil, France
| | - Sandra Teysseire
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud Pierre Bénite, Department of Dermatology, 69002 Lyon, France
| | - François-Xavier Danlos
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Laurence Albiges
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Charlotte Bernigaud
- Assistance Publique - Hôpitaux de Paris, Henri Mondor Hospital, Dermatology Department, 94000 Créteil, France
| | - Marc-Antoine Benderra
- Assistance Publique - Hôpitaux de Paris, Tenon Hospital, Department of Medical Oncology, 75020 Paris, France
| | - Pauline Pradère
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Mohamad Zaidan
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Nephrology Department, 94270 Le Kremlin-Bicêtre, France
| | - Chantal Decroisette
- Centre Hospitalier Annecy Genevois, Department of Medical Oncology, 74374 Pringy, France
| | - Fatma Fallah
- Centre Hospitalier Argenteuil, Department of Medical Oncology, 95107 Argenteuil, France
| | - Gaelle Matergia
- Hôpital-Clinique Claude Bernard, Department of Medical Oncology, 57070 Metz, France
| | - Pernelle Lavaud
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Hélène Jantzem
- Centre Hospitalier Universitaire de Brest, Department of Pharmacovigilance, Centre Régional de Pharmacovigilance, 29609 Brest, France
| | - Marina Atzenhoffer
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud Pierre Bénite, Department of Clinical Pharmacology and Pharmacovigilance, 69002 Lyon, France
| | - Véronique Buyse
- O.L.V. van Lourdes Ziekenhuis Waregem, Vijfseweg 150, 8790 Waregem, Belgium; Oncologie, Vijfseweg 150, B-8790 Waregem, Belgium
| | - Samy Ammari
- Gustave Roussy - Paris-Saclay University, Radiology Department, 94800 Villejuif, France
| | - Caroline Robert
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Sabine Messayke
- Gustave Roussy - Paris-Saclay University, Pharmacovigilance Unit, 94800 Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Catherine Guettier
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Department of Pathology, UMR-S 1193, 94270 Le Kremlin Bicêtre, France
| | - Céleste Lebbe
- Assistance Publique - Hôpitaux de Paris, University of Paris, Department of Dermatology, DMU ICARE, Saint Louis Hospital, INSERM U976 HIPI, Team 1, F-75010 Paris, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Internal Medicine Department, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Marie Michot
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France; Gustave Roussy, INSERM U1170, Université Paris-Saclay, Villejuif, France.
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Li GM, Li YF, Zeng QQ, Zhang XM, Liu HM, Feng JY, Shi Y, Wu BB, Xu H, Sun L. Lupus podocytopathy and antiphospholipid syndrome in a child with SLE: A case report and literature review. Front Pediatr 2022; 10:950576. [PMID: 36061375 PMCID: PMC9437347 DOI: 10.3389/fped.2022.950576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Lupus podocytopathy is a glomerular lesion in systemic lupus erythematosus (SLE) characterized by diffuse podocyte foot process effacement (FPE) without immune complex (IC) deposition or with only mesangial IC deposition. It is rarely seen in children with SLE. A 13-year-old girl met the 2019 European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) Classification Criteria for SLE based on positive ANA; facial rash; thrombocytopenia; proteinuria; and positive antiphospholipid (aPL) antibodies, including lupus anticoagulant (LAC), anti-β2 glycoprotein-I antibody (anti-β2GPI), and anti-cardiolipin antibody (aCL). The renal lesion was characterized by 3+ proteinuria, a 4.2 mg/mg spot (random) urine protein to creatinine ratio, and hypoalbuminemia (26.2 g/l) at the beginning of the disease. Kidney biopsy findings displayed negative immunofluorescence (IF) for immunoglobulin A (IgA), IgM, fibrinogen (Fb), C3, and C1q, except faint IgG; a normal glomerular appearance under a light microscope; and diffuse podocyte foot process effacement (FPE) in the absence of subepithelial or subendothelial deposition by electron microscopy (EM). Histopathology of the epidermis and dermis of the pinna revealed a hyaline thrombus in small vessels. The patient met the APS classification criteria based on microvascular thrombogenesis and persistently positive aPL antibodies. She responded to a combination of glucocorticoids and immunosuppressive agents. Our study reinforces the need to consider the potential cooccurrence of LP and APS. Clinicians should be aware of the potential presence of APS in patients with a diagnosis of LP presenting with NS and positivity for aPL antibodies, especially triple aPL antibodies (LCA, anti-β2GPI, and aCL).
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Affiliation(s)
- Guo-Min Li
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi-Fan Li
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Qiao-Qian Zeng
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Mei Zhang
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Hai-Mei Liu
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jia-Yan Feng
- National Children's Medical Center, Shanghai, China.,Department of Pathology, Children's Hospital of Fudan University, Shanghai, China
| | - Yu Shi
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Bing-Bing Wu
- National Children's Medical Center, Shanghai, China.,Medical Transformation Centre, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- National Children's Medical Center, Shanghai, China.,Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Li Sun
- National Children's Medical Center, Shanghai, China.,Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
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Liu L, Murray B, Tomaszewski JE. Lupus podocytopathy superimposed on diabetic glomerulosclerosis: A case report. Medicine (Baltimore) 2021; 100:e27077. [PMID: 34664831 PMCID: PMC8448049 DOI: 10.1097/md.0000000000027077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Lupus podocytopathy (LP) is an entity that is increasingly being reported in the literature on systemic lupus erythematosus (SLE). LP is characterized by nephrotic syndrome in SLE patients with diffuse glomerular podocyte foot process effacement and no immune complex deposits along the capillary loops. Histologically, LP typically mimics minimal change disease or primary focal segmental glomerulosclerosis (FSGS) on a background of ISN/RPS class I or II lupus nephritis. In situations where there are coexistent glomerular diseases, however, LP may be easily masked by background lesions and overlapping clinical symptoms. PATIENT CONCERNS We report the case of a 24-year-old woman with type I diabetes, hypertension, psoriasis/rash, and intermittent arthritis who presented with abrupt onset of severe nephrotic proteinuria and renal insufficiency. Renal biopsy revealed nodular glomerulosclerosis and FSGS. Immune deposits were not identified by immunofluorescence or electron microscopy. Ultrastructurally, there was diffuse glomerular basement membrane thickening and over 90% podocyte foot process effacement. With no prior established diagnosis of SLE, the patient was initially diagnosed with diabetic nephropathy with coexistent FSGS, and the patient was started on angiotensin-converting enzyme inhibitors (ACEI) and diuretics. However, nephrotic proteinuria persisted and renal function deteriorated. The patient concurrently developed hemolytic anemia with pancytopenia. DIAGNOSES Subsequent to the biopsy, serologic results showed positive autoantibodies against double strand DNA (dsDNA), Smith antigen, ribonucleoprotein (RNP), and Histone. A renal biopsy was repeated, revealing essentially similar findings to those of the previous biopsy. Integrating serology and clinical presentation, SLE was favored. The pathology findings were re-evaluated and considered to be most consistent with LP and coexistent diabetic nephropathy, with superimposed FSGS either as a component of LP or as a lesion secondary to diabetes or hypertension. INTERVENTIONS The patient was started on high-dose prednisone at 60 mg/day, with subsequent addition of mycophenolate mofetil and ACEI, while prednisone was gradually tapered. OUTCOMES The patient's proteinuria, serum creatinine, complete blood counts, skin rash, and arthritis were all significantly improved. CONCLUSION The diagnosis of LP when confounded by other glomerular diseases that may cause nephrotic syndrome can be challenging. Sufficient awareness of this condition is necessary for the appropriate diagnosis and treatment.
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Affiliation(s)
- Lin Liu
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Brian Murray
- Department of Internal Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, NY
| | - John E. Tomaszewski
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
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