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 four-weeks after drug administration, responses to conventional immunotherapies were excellent and autoantibodies traditionally associated with their syndrome were absent. Indeed, 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.

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