Objective

The purpose of the present study is to report the clinical characteristics of polyradiculoneuropathy induced by immune checkpoint inhibitors (ICIs).

Methods

We retrospectively reviewed lists of all inpatients with neurological immune-related adverse events (irAEs) treated at the neurology departments of three hospitals in January 2017 and December 2019. We also performed a review of the previous case reports with polyradiculoneuropathy induced by ICI therapy.

Results

We had 4 patients with polyradiculoneuropathy following ICI therapy. We comprehensively reviewed our 4 patients and 32 previous case reports. There were 28 men and 8 women with a mean onset age of 61 years. ICI monotherapy was performed in 27 patients, whereas the combination of ICIs was administered in 9 patients. All patients except 2 showed limb weakness, which was observed symmetrically and predominantly in the legs rather than the arms. Bulbar involvement was observed in 7 patients. The laboratory findings were demyelination in electrophysiological studies and elevated protein with lymphocytes in the cerebrospinal fluid. Disease severity was ranked on the Hughes functional scale; 17 patients were grade 4 or greater. The treatment responses to corticosteroid and intravenous methylprednisolone were favorable. Intravenous immunoglobulin was also used in combination with steroids. Seven patients died, including 4 who on mechanical ventilation.

Conclusion

Polyradiculoneuropathy induced by ICIs has a distinct subset of neurological irAEs and requires early recognition.

中文翻译：

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免疫检查点抑制剂诱导的多发性神经根病：一个病例系列和文献综述。

目的

本研究的目的是报告由免疫检查点抑制剂（ICIs）诱发的多发性神经根神经病的临床特征。

方法

我们回顾性分析了2017年1月和2019年12月在三家医院神经内科治疗的所有神经免疫相关不良事件（irAE）住院患者的名单。我们还对以前由ICI治疗诱发的多发性神经根病的病例报告进行了回顾。

结果

ICI治疗后有4例多发性神经根神经病患者。我们全面审查了4例患者和32例以前的病例报告。有28名男性和8名女性，平均发病年龄为61岁。ICI单药治疗27例，而ICI联合治疗9例。除2名患者外，所有患者均显示肢体无力，主要是在腿部而不是手臂上观察到对称性。观察到球囊受累7例。实验室检查的结果是，在电生理研究中出现脱髓鞘，脑脊液中的淋巴细胞蛋白升高。疾病严重程度按休斯功能量表排名；17名4级或更高级别的患者。对皮质类固醇和静脉注射甲基泼尼松龙的治疗反应良好。静脉注射免疫球蛋白也与类固醇联合使用。7例患者死亡，其中4例采用机械通气。

结论

由ICI引起的多发性神经根神经病具有神经性irAE的不同子集，需要早期识别。