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B cell-driven refractory hemocytopenia in immune checkpoint inhibitor therapy: a report of two cases
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DOI：10.21037/tlcr-2025-939.png)
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Abstract
En 中文
Background: The integration of immune checkpoint inhibitors (ICIs) with chemotherapy has revolutionized lung cancer treatment, yet it amplifies the risk of severe hematologic toxicities. Case Description: We describe two patients with advanced lung cancer who developed life-threatening refractory hemocytopenia following ICIs-chemotherapy, unresponsive to glucocorticoids and hematopoietic growth factors. A striking feature of these cases was the exclusive presence of anti-Sj & ouml;gren's-syndromerelated antigen A (Ro) (SSA) antibodies in refractory patients, but absent in non-refractory controls. Targeted administration of intravenous immunoglobulin (IVIG) and rituximab was temporally associated with clearance of anti-SSA antibodies and restoration of normal hematopoiesis, raising the hypothesis that aberrant B cell activity may contribute to refractory hemocytopenia in this setting. Conclusions: These observations suggest that anti-SSA antibodies could represent a candidate biomarker for identifying refractory hemocytopenia in early time. These findings support a proposal for routine antiSSA screening in ICI-related hematologic toxicity to enable timely B cell-targeted management.
Keywords:
Refractory hemocytopenia
immune checkpoint inhibitors (ICIs)
anti-Sj & ouml
gren's-syndrome-related
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