{"id":9072,"date":"2019-04-27T00:44:15","date_gmt":"2019-04-26T17:44:15","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=9072"},"modified":"2019-05-05T00:44:43","modified_gmt":"2019-05-04T17:44:43","slug":"phan-ung-mien-dich-co-hai-hiem-gap-nhung-nghiem-trong-tren-huyet-hoc-cua-cac-thuoc-uc-che-diem-kiem-soat-mien-dich","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/phan-ung-mien-dich-co-hai-hiem-gap-nhung-nghiem-trong-tren-huyet-hoc-cua-cac-thuoc-uc-che-diem-kiem-soat-mien-dich\/","title":{"rendered":"Ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i hi\u1ebfm g\u1eb7p nh\u01b0ng nghi\u00eam tr\u1ecdng tr\u00ean huy\u1ebft h\u1ecdc c\u1ee7a c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch"},"content":{"rendered":"

Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch nh\u01b0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf PD1 v\u00e0 PD-L1 (\u0111\u1eb7c bi\u1ec7t l\u00e0 nivolumab v\u00e0 pembrolizumab) \u0111\u00e3 tr\u1edf th\u00e0nh c\u00e1c thu\u1ed1c quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 lo\u1ea1i ung th\u01b0 (u s\u1eafc t\u1ed1 di c\u0103n, ung th\u01b0 ph\u1ed5i, v.v.). S\u1ef1 gia t\u0103ng s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y \u0111i c\u00f9ng v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i \u1edf m\u1ecdi m\u1ee9c \u0111\u1ed9<\/p>\n

Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch nh\u01b0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf PD1 v\u00e0 PD-L1 (\u0111\u1eb7c bi\u1ec7t l\u00e0 nivolumab v\u00e0 pembrolizumab) \u0111\u00e3 tr\u1edf th\u00e0nh c\u00e1c thu\u1ed1c quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 lo\u1ea1i ung th\u01b0 (u s\u1eafc t\u1ed1 di c\u0103n, ung th\u01b0 ph\u1ed5i, v.v.). S\u1ef1 gia t\u0103ng s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c n\u00e0y \u0111i c\u00f9ng v\u1edbi s\u1ef1 xu\u1ea5t hi\u1ec7n ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i \u1edf m\u1ecdi m\u1ee9c \u0111\u1ed9 v\u1edbi tr\u00ean 71% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, trong \u0111\u00f3 c\u00e1c ph\u1ea3n \u1ee9ng \u0111\u1ed9 3-4 chi\u1ebfm 10%. C\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i ch\u1ee7 y\u1ebfu bao g\u1ed3m c\u00e1c \u1ea3nh h\u01b0\u1edfng tr\u00ean da, h\u1ec7 ti\u00eau h\u00f3a, tuy\u1ebfn gi\u00e1p, gan v\u00e0 c\u00e1c kh\u1edbp (theo BIP Occitanie 2018,25, 52)<\/p>\n

Theo m\u1ed9t c\u00f4ng b\u1ed1 g\u1ea7n \u0111\u00e2y (tr\u00ean t\u1ea1p ch\u00ed Lancet Haematol 2019.6, e48-e57), c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean huy\u1ebft h\u1ecdc c\u00f3 th\u1ec3 li\u00ean quan t\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch, m\u1eb7c d\u00f9 t\u1ea7n su\u1ea5t g\u1eb7p th\u1ea5p h\u01a1n nhi\u1ec1u so v\u1edbi c\u00e1c thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o c\u1ed5 \u0111i\u1ec3n. Nghi\u00ean c\u1ee9u quan s\u00e1t n\u00e0y \u0111\u00e3 ph\u00e2n t\u00edch t\u1ea5t c\u1ea3 c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean huy\u1ebft h\u1ecdc c\u00f3 m\u1ee9c \u0111\u1ed9 > 2 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf PD1\/PD-L1.<\/p>\n

\"Ph\u1ea3n<\/p>\n

Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb 3 nghi\u00ean c\u1ee9u c\u1ea3nh gi\u00e1c d\u01b0\u1ee3c t\u1ea1i Ph\u00e1p. T\u1eeb n\u0103m 2014 \u0111\u1ebfn n\u0103m 2018, trong t\u1ed5ng s\u1ed1 948 b\u1ec7nhnh\u00e2n t\u1eeb 3 nghi\u00ean c\u1ee9u, 35 b\u1ec7nh nh\u00e2n \u0111\u00e3 xu\u1ea5t hi\u1ec7n c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean h\u1ec7 huy\u1ebft h\u1ecdc c\u00f3 m\u1ee9c \u0111\u1ed9 l\u1edbn h\u01a1n2, \u0111\u01b0\u1ee3c coi c\u00f3 m\u1ed1i li\u00ean h\u1ec7 v\u1edbi nivolumab (20 b\u1ec7nh nh\u00e2n), pembrolizumab (14 b\u1ec7nh nh\u00e2n) ho\u1eb7c atezolizumab (1 b\u1ec7nh nh\u00e2n) s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb li\u1ec7u (94%). Trong 35 tr\u01b0\u1eddng h\u1ee3p n\u00e0y, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, thi\u1ebfu m\u00e1u tan m\u00e1u t\u1ef1 mi\u1ec5n v\u00e0 gi\u1ea3m ti\u1ec3u c\u1ea7u do c\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch l\u00e0 c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch ph\u1ed1 bi\u1ec3n nh\u1ea5t tr\u00ean huy\u1ebft h\u1ecdc (m\u1ed7i ph\u1ea3n \u1ee9ng xu\u1ea5t hi\u1ec7n \u1edf 9 b\u1ec7nh nh\u00e2n, chi\u1ebfm t\u1ec9 l\u1ec7 26%), ti\u1ebfp theo l\u00e0 gi\u1ea3m ba d\u00f2ng t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi ho\u1eb7c thi\u1ebfu m\u00e1u b\u1ea5t s\u1ea3n \u1edf 5 b\u1ec7nh nh\u00e2n (chi\u1ebfm 14%), gi\u1ea3m hai d\u00f2ng t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi (2 b\u1ec7nh nh\u00e2n, chi\u1ebfm 6%) v\u00e0 b\u1ea5t s\u1ea3n h\u1ed3ng c\u1ea7u nguy\u00ean ph\u00e1t (1 b\u1ec7nh nh\u00e2n, chi\u1ebfm 3%). Trung v\u1ecb th\u1eddi gian x\u1ea3y ra ph\u1ea3n \u1ee9ng l\u00e0 10,1 tu\u1ea7n.<\/p>\n

C\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean huy\u1ebft h\u1ecdc x\u1ea3y ra \u1edf m\u1ee9c \u0111\u1ed9 n\u1eb7ng, 25 b\u1ec7nh nh\u00e2n \u1edf \u0111\u1ed9 4 (chi\u1ebfm 71%) v\u00e0 2 b\u1ec7nh nh\u00e2n \u0111\u1ed9 5 (t\u1eed vong li\u00ean quan \u0111\u1ebfn gi\u1ea3m b\u1ec7nh c\u1ea7u do s\u1ed1t, chi\u1ebfm 6%). \u0110\u1ec1 \u0111i\u1ec1u tr\u1ecb c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean huy\u1ebft h\u1ecdc, 22 tr\u00ean 35 b\u1ec7nh nh\u00e2n (chi\u1ebfm 63%) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng corticosteroid \u0111\u01b0\u1eddng u\u1ed1ng, 5 b\u1ec7nh nh\u00e2n (chi\u1ebfm 14%) s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 \u0111\u01b0\u1eddng u\u1ed1ng, 11 b\u1ec7nh nh\u00e2n (chi\u1ebfm 14%) ti\u00eam t\u0129nh m\u1ea1ch immunoglobulin v\u00e0 7 b\u1ec7nh nh\u00e2n (chi\u1ebfm 20%) d\u00f9ng rituximab. 80% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e3 ng\u1eebng d\u00f9ng thu\u1ed1c v\u0129nh vi\u1ec5nv\u00e0 ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i \u0111\u00e3 h\u1ed3i ph\u1ee5c tr\u00ean 60% s\u1ed1 b\u1ec7nh nh\u00e2n.<\/p>\n

Nghi\u00ean c\u1ee9u quan s\u00e1t n\u00e0y \u0111\u00e3 n\u00e2ng cao nh\u1eadn th\u1ee9c c\u1ee7a chuy\u00ean gia y t\u1ebf v\u1ec1 c\u00e1c ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch c\u00f3 h\u1ea1i tr\u00ean huy\u1ebft h\u1ecdc, c\u00f3 kh\u1ea3 n\u0103ng \u1edf m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 khuy\u1ebfn kh\u00edch vi\u1ec7c t\u00ecm ki\u1ebfm c\u00e1c ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 x\u1eed tr\u00ed s\u1edbm. T\u1ea5t c\u1ea3 c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c \u0111\u1ec1u c\u1ea7n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o cho c\u00e1c trung t\u00e2m c\u1ea3nh gi\u00e1c d\u01b0\u1ee3ckhu v\u1ef1c.<\/p>\n

T\u00ean b\u00e0i g\u1ed1c: Les e\ufb00ets ind\u00e9sirables h\u00e9matologiques immunologiques des inhibiteurs de check-point immunologiques : rares mais “grave”<\/p>\n

Ngu\u1ed3n: T\u1ea1p ch\u00ed BIP Occitanie 2019;26(1):8.<\/p>\n

T\u00e1c gi\u1ea3: BS. Pascale Olivier \u2013 Toulouse<\/p>\n

Ng\u01b0\u1eddi d\u1ecbch: DS V\u0169 \u0110\u1ee9c Ho\u00e0n \u2013 ThS D\u01b0\u01a1ng Kh\u00e1nh Linh<\/p>\n

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Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch nh\u01b0 c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf PD1 v\u00e0 PD-L1 (\u0111\u1eb7c bi\u1ec7t l\u00e0 nivolumab v\u00e0 pembrolizumab) \u0111\u00e3 tr\u1edf th\u00e0nh c\u00e1c thu\u1ed1c quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 lo\u1ea1i ung th\u01b0 (u s\u1eafc t\u1ed1 di c\u0103n, ung th\u01b0 ph\u1ed5i, v.v.). S\u1ef1 gia t\u0103ng s\u1eed […]\n","protected":false},"author":1,"featured_media":9074,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9072","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/9072","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=9072"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/9072\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/9074"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=9072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=9072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=9072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}