Checkpoint inhibitor-related renal vasculitis and use of rituximab
The percentage of patients with cancer eligible for checkpoint inhibitor (CPI) therapy has increased rapidly over the past few years and approaches 45%. As a result, more cases of CPI-related nephrotoxicity, including a rare subset with vasculitis, are being reported. To elucidate the clinical prese...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-10-01
|
| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/8/2/e000750.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850196216509366272 |
|---|---|
| author | Noha Abdel-Wahab Ala Abudayyeh Omar Mamlouk Umut Selamet Jamie S Lin Maryam Buni Amanda S Tchakarov |
| author_facet | Noha Abdel-Wahab Ala Abudayyeh Omar Mamlouk Umut Selamet Jamie S Lin Maryam Buni Amanda S Tchakarov |
| author_sort | Noha Abdel-Wahab |
| collection | DOAJ |
| description | The percentage of patients with cancer eligible for checkpoint inhibitor (CPI) therapy has increased rapidly over the past few years and approaches 45%. As a result, more cases of CPI-related nephrotoxicity, including a rare subset with vasculitis, are being reported. To elucidate the clinical presentation of CPI-associated renal vasculitis and its possible mechanisms, treatment options and prognosis, we describe cases from a comprehensive cancer center and reviewed the literature for similar cases. We retrospectively reviewed the charts of all patients with cancer from 2014 to 2020 who were diagnosed with CPI-related nephrotoxicity and underwent a kidney biopsy. We identified five cases of renal vasculitis: three patients were diagnosed with seronegative antineutrophil cytoplasm antibody (ANCA)-associated vasculitis, one case with seropositive ANCA-associated vasculitis and one case was diagnosed with IgA vasculitis. Of these cases, four patients were receiving nivolumab, and one patient was receiving tremelimumab. All patients had microscopic hematuria, four out of five patients had negative ANCA serology, one patient had concurrent lung involvement and positive ANCA serology, and all had severe acute kidney injury with creatinine >4.50 mg/dL on diagnosis. All patients were treated by discontinuing CPI and initiating corticosteroids and rituximab. Three patients received plasmapheresis; two of these required renal replacement therapy including the patient with lung involvement. All patients after rituximab had a partial or complete renal response. Two patients died within 8 months of diagnosis due to malignancy progression. None of the patients had a relapse of vasculitis. We demonstrated that CPI can be associated with different types of renal vasculitis that are predominantly ANCA negative and manifest as severe acute kidney injury. Despite the lack of strong evidence, treatment similar to treatment of primary seropositive ANCA-associated vasculitis with corticosteroids and rituximab is well tolerated with favorable renal outcomes. |
| format | Article |
| id | doaj-art-cb311ca2a76f4c5cb497c931faeafe55 |
| institution | OA Journals |
| issn | 2051-1426 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj-art-cb311ca2a76f4c5cb497c931faeafe552025-08-20T02:13:31ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262020-10-018210.1136/jitc-2020-000750Checkpoint inhibitor-related renal vasculitis and use of rituximabNoha Abdel-Wahab0Ala Abudayyeh1Omar Mamlouk2Umut Selamet3Jamie S Lin4Maryam Buni5Amanda S Tchakarov62Faculty of Medicine, Assiut University Hospital, Department of Rheumatology and Rehabilitation, Assiut, Egypt1 Division of Internal Medicine, Section of Nephrology, University of Texas MD Anderson Cancer Center, Houston, Texas, USADivison of Internal Medicine, Section of Nephrology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA4 Division of Renal Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USADivison of Internal Medicine, Section of Nephrology, University of Texas MD Anderson Cancer Center, Houston, Texas, USAUniversity of Texas MD Anderson Cancer Center, Houston, Texas, USA3 Department of Pathology and Laboratory Medicine, University of Texas Health Science Center McGovern Medical School, Houston, Texas, USAThe percentage of patients with cancer eligible for checkpoint inhibitor (CPI) therapy has increased rapidly over the past few years and approaches 45%. As a result, more cases of CPI-related nephrotoxicity, including a rare subset with vasculitis, are being reported. To elucidate the clinical presentation of CPI-associated renal vasculitis and its possible mechanisms, treatment options and prognosis, we describe cases from a comprehensive cancer center and reviewed the literature for similar cases. We retrospectively reviewed the charts of all patients with cancer from 2014 to 2020 who were diagnosed with CPI-related nephrotoxicity and underwent a kidney biopsy. We identified five cases of renal vasculitis: three patients were diagnosed with seronegative antineutrophil cytoplasm antibody (ANCA)-associated vasculitis, one case with seropositive ANCA-associated vasculitis and one case was diagnosed with IgA vasculitis. Of these cases, four patients were receiving nivolumab, and one patient was receiving tremelimumab. All patients had microscopic hematuria, four out of five patients had negative ANCA serology, one patient had concurrent lung involvement and positive ANCA serology, and all had severe acute kidney injury with creatinine >4.50 mg/dL on diagnosis. All patients were treated by discontinuing CPI and initiating corticosteroids and rituximab. Three patients received plasmapheresis; two of these required renal replacement therapy including the patient with lung involvement. All patients after rituximab had a partial or complete renal response. Two patients died within 8 months of diagnosis due to malignancy progression. None of the patients had a relapse of vasculitis. We demonstrated that CPI can be associated with different types of renal vasculitis that are predominantly ANCA negative and manifest as severe acute kidney injury. Despite the lack of strong evidence, treatment similar to treatment of primary seropositive ANCA-associated vasculitis with corticosteroids and rituximab is well tolerated with favorable renal outcomes.https://jitc.bmj.com/content/8/2/e000750.full |
| spellingShingle | Noha Abdel-Wahab Ala Abudayyeh Omar Mamlouk Umut Selamet Jamie S Lin Maryam Buni Amanda S Tchakarov Checkpoint inhibitor-related renal vasculitis and use of rituximab Journal for ImmunoTherapy of Cancer |
| title | Checkpoint inhibitor-related renal vasculitis and use of rituximab |
| title_full | Checkpoint inhibitor-related renal vasculitis and use of rituximab |
| title_fullStr | Checkpoint inhibitor-related renal vasculitis and use of rituximab |
| title_full_unstemmed | Checkpoint inhibitor-related renal vasculitis and use of rituximab |
| title_short | Checkpoint inhibitor-related renal vasculitis and use of rituximab |
| title_sort | checkpoint inhibitor related renal vasculitis and use of rituximab |
| url | https://jitc.bmj.com/content/8/2/e000750.full |
| work_keys_str_mv | AT nohaabdelwahab checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT alaabudayyeh checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT omarmamlouk checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT umutselamet checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT jamieslin checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT maryambuni checkpointinhibitorrelatedrenalvasculitisanduseofrituximab AT amandastchakarov checkpointinhibitorrelatedrenalvasculitisanduseofrituximab |