Decreased Absolute Lymphocyte Count and Increased Neutrophil/Lymphocyte Ratio With Immune Checkpoint Inhibitor–Associated Myocarditis

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Zsofia D. Drobni¹  Charlotte Lee¹  Tomas G. Neilan¹  Sarah Hartmann¹  Amna Zafar¹  Raza M. Alvi¹  Hannah K. Gilman¹  Anju Nohria²  John D. Groarke²  Daniel A. Zlotoff³  Leyre Zubiri³  Lili Zhang⁴  Alexandra‐Chloe Villani⁵  Kerry L. Reynolds⁵  Ryan J. Sullivan⁵ 

[1] Cardiovascular Imaging Research Center Department of Radiology and Division of Cardiology Massachusetts General HospitalHarvard Medical School Boston MA;Cardio‐Oncology Program Division of Cardiology Brigham and Women’s Hospital Harvard Medical School Boston MA;Cardio‐Oncology Program Division of Cardiology Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA;Cardio‐Oncology Program Division of Cardiology Department of Medicine Montefiore Medical CenterAlbert Einstein College of Medicine Bronx NY;Division of Oncology and Hematology Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA;

关键词: immune checkpoint inhibitor;    lymphocyte;    myocarditis;    oncology;   

DOI  :  10.1161/JAHA.120.018306

来源: DOAJ

【 摘 要 】

Background Myocarditis attributable to immune checkpoint inhibitor (ICI) therapy is a potentially fatal immune‐related adverse event. Limited data have suggested an association between baseline and on‐treatment absolute lymphocyte count (ALC) and neutrophil/lymphocyte ratio (NLR) and the development of other immune‐related adverse events; there are no data characterizing the role of ALC and NLR in ICI‐associated myocarditis. Methods and Results This was a case control study of 55 patients with ICI myocarditis and 55 controls without any post‐ICI immune‐related adverse events. We leveraged clinical testing, where patients underwent routine serial blood counts before and with each ICI cycle to compare the baseline and change in ALC and NLR between cases and controls. The association between the change in these parameters with clinical variables and major adverse cardiac events was also tested. In cases, there was a statistically significant decrease in ALC with myocarditis from baseline (1.6 thousands per cubic milliliter (K/μL); interquartile range, 1.1–1.9 K/μL) to admission (1.1 K/μL; interquartile range, 0.7–1.3 K/μL; P<0.001). Similarly, there was an increase in NLR from baseline (3.5; interquartile range, 2.3–5.4) to admission (6.6; interquartile range, 4.5–14.1; P<0.001). There was no statistically significant change in controls. In follow‐up, there were 20 events; larger decreases in ALC (44.6% versus 18.2%; P<0.001) or increases in NLR (156.5% versus 65.1%; P=0.019) were associated with major adverse cardiac events. Conclusions A reduction in ALC and an increase in NLR was seen with ICI myocarditis. A greater decrease in ALC or increase in NLR was associated with subsequent major adverse cardiac events.

【 授权许可】

Unknown