免疫检查点抑制剂 (ICIs) 是一种刺激 T 细胞功能的药物，已成为不可切除的肝细胞癌 (HCC) 的标准一线治疗方法。然而，它们也可能引起免疫相关的不良事件（irAE），这种情况很少见且尚未广泛报道。在此，我们描述一例 atezolizumab 联合贝伐单抗 (atezo/bev) 治疗后出现严重发热性中性粒细胞减少症和全血细胞减少症的病例及其治疗过程。atezo/bev 联合治疗最初是一位 5​​0 岁出头男性的一线治疗，被诊断为无法切除的肝癌。第一个治疗周期在门诊进行，治疗开始10天后患者出现发烧39.0℃。 5天后，他出现持续发烧、头痛、呕吐、发冷、全身疼痛、疲劳、轻度腹部不适，颈部和面部出现烧灼感皮疹。全血细胞计数显示严重中性粒细胞减少症[中性粒细胞绝对计数 (ANC) 为 90 个细胞/μL]、白细胞减少症[白细胞 (WBC) 计数为 500 个细胞/μL]、血小板减少症[血小板计数 (PC) 18,000 个细胞/μL] 和轻度贫血（血红蛋白水平 12.6 gm/dL）。影像学检查结果显示计算机断层扫描（CT）显示结肠炎。停止 Atezo/bev 治疗。治疗计划包括头孢吡肟和非格司亭（一种用于治疗发热性中性粒细胞减少症的天然粒细胞集落刺激因子（G-CSF）的重组形式）、用于治疗结肠炎的甲硝唑以及用于治疗免疫相关毒性的静脉注射甲泼尼龙。患者入院 4 天后完全康复。 总之，我们在一名不可切除的 HCC 患者的全身免疫治疗过程中观察到暂时性严重发热性中性粒细胞减少症和全血细胞减少症。医疗保健提供者应考虑 ICI 给药后患者的血液学 irAE（hem-irAE）。2024 年胃肠肿瘤学杂志。版权所有。

Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a fever of 39.0 ℃ 10 days after therapy initiation. He presented 5 days later with persistent fever as well as a headache, vomiting, chills, generalized pain, fatigue, mild abdominal discomfort, and a burning rash present on his neck and face. Complete blood counts showed severe neutropenia [absolute neutrophil count (ANC) of 90 cells/µL], leukopenia [white blood cell (WBC) count 500 cells/µL], thrombocytopenia [platelet count (PC) 18,000 cells/µL], and mild anemia (hemoglobin level 12.6 gm/dL). Imaging findings showed colitis on computed tomography (CT). Atezo/bev therapy was discontinued. Treatment plan constituted of cefepime and filgrastim, a recombinant form of the naturally occurring granulocyte colony-stimulating factor (G-CSF) for febrile neutropenia, metronidazole for colitis, and intravenous methylprednisolone for immune-related toxicities. The patient fully recovered after 4 days of admission.In conclusion, we observed temporary severe febrile neutropenia and pancytopenia during systemic immunotherapy in a patient with unresectable HCC. Healthcare providers should consider hematological irAEs (hem-irAEs) in patients after the administration of ICIs.2024 Journal of Gastrointestinal Oncology. All rights reserved.