Neuromyelitis Optica Spectrum Disorder after treatment with pembrolizumab

Publication date: Available online 14 October 2019Source: Multiple Sclerosis and Related DisordersAuthor(s): Tomoyo Shimada, Yasunobu Hoshino, Taiji Tsunemi, Anri Hattori, Emi Nakagawa, Kazumasa Yokoyama, Nobutaka HattoriAbstractWhile immune checkpoint inhibitors (ICIs) have contributed to the development of therapeutic treatments for previously incurable advanced malignancies, they may induce immune-related adverse events (irAEs) in many organs including the CNS [1]. Because immune checkpoint molecules are predominantly expressed on T cells, irAEs are largely not B cell-mediated. Here, we report a patient who was treated with pembrolizumab (a PD-1 monoclonal antibody) for lung adenocarcinoma with brain metastasis, and who developed anti-aquaporin-4 antibody (AQP4-Ab) positive neuromyelitis optica spectrum disorder (NMOSD). We hypothesized that PD-1 immune checkpoint blockage might induce a B cell-mediated immune response in CNS resulting in this complication, which was further supported by the observation of a transient increase in plasmablasts in their CSF.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research