Severe acute myositis and myocarditis on initiation of 6-weekly pembrolizumab post-COVID-19 mRNA vaccination.
Robert A WatsonWeiyu YeChelsea A TaylorElsita JungkurthRosalin CooperOrion TongTim JamesBrian ShineMonika HoferDamian JenkinsRobert PellEleni IeremiaStephanie JonesDavid Maldonado-PerezIan S D RobertsNicholas CoupeMark Ross MiddletonMiranda J PayneBenjamin P FairfaxPublished in: Journal for immunotherapy of cancer (2024)
We describe three cases of critical acute myositis with myocarditis occurring within 22 days of each other at a single institution, all within 1 month of receiving the initial cycle of the anti-PD-1 drug pembrolizumab. Analysis of T cell receptor repertoires from peripheral blood and tissues revealed a high degree of clonal expansion and public clones between cases, with several T cell clones expanded within the skeletal muscle putatively recognizing viral epitopes. All patients had recently received a COVID-19 mRNA booster vaccine prior to treatment and were positive for SARS-CoV2 Spike antibody. In conclusion, we report a series of unusually severe myositis and myocarditis following PD-1 blockade and the COVID-19 mRNA vaccination.
Keyphrases
- sars cov
- coronavirus disease
- respiratory syndrome coronavirus
- skeletal muscle
- peripheral blood
- interstitial lung disease
- end stage renal disease
- binding protein
- ejection fraction
- newly diagnosed
- myasthenia gravis
- drug induced
- chronic kidney disease
- gene expression
- liver failure
- healthcare
- advanced non small cell lung cancer
- prognostic factors
- early onset
- mental health
- peritoneal dialysis
- intensive care unit
- patient reported outcomes
- combination therapy
- adverse drug
- hepatitis b virus
- aortic dissection
- extracorporeal membrane oxygenation