Seronegative antibody-mediated neurology after immune checkpoint inhibitors.

Abstract

Checkpoint inhibitor medications have revolutionized oncology practice, but frequently induce immune-related adverse events. During autoimmune neurology practice over 20 months, we prospectively identified four patients with likely antibody-mediated neurological diseases after checkpoint inhibitors: longitudinally extensive transverse myelitis, Guillain-Barré syndrome, and myasthenia gravis. All patients shared three characteristics: symptoms commenced 4 weeks after drug administration, responses to conventional immunotherapies were excellent, and autoantibodies traditionally associated with their syndrome were absent. However, serum immunoglobulins from the myelitis and Guillain-Barré syndrome patients showed novel patterns of tissue reactivity. Vigilance is required for antibody-mediated neurology after checkpoint inhibitor administration. This phenomenon may inform the immunobiology of antibody-mediated diseases.

• Authors: Robert Wilson, David A Menassa, Alexander J Davies, Sophia Michael, Joanna Hester, Wilhelm Kuker, Graham P Collins, Judith Cossins, David Beeson, Neil Steven, Paul Maddison, Simon Rinaldi, Saiju Jacob, Sarosh R Irani
• Journal: Annals of clinical and translational neurology (Ann Clin Transl Neurol) Vol. 5 Issue 5 Pg. 640-645 (May 2018) ISSN: 2328-9503 [Print] United States
• PMID: 29761126 (Publication Type: Journal Article)