{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:41:11Z","timestamp":1787312471285,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Pembrolizumab (mAb to PD-1) has been recently approved for the therapy of pretreated urothelial cancer. Despite the efficacy, it is often accompanied by unpredictable and sometime severe immune-related (ir) adverse events (AEs). Here, we report the clinical and immune\u2013biological characterization of a patient with a metastatic bladder cancer who developed myositis signs (M) and a myasthenia-like syndrome (MLS) during treatment with pembrolizumab. The patient presented an autoimmunity-associated HLA haplotype (HLA-A*02\/HLA-B*08\/HLA-C*07\/HLA-DRB1*03) and experienced an increase in activated CD8 T-cells along the treatment. The symptomatology regressed after pembrolizumab discontinuation and a pyridostigmine and steroids-based therapy. This is the first report of concurrent M and MLS appearance in cancer patients receiving pembrolizumab. More efforts are needed to define early the risk and the clinical meaning of irAEs in this setting.<\/jats:p>","DOI":"10.3390\/ijms22126246","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T13:31:39Z","timestamp":1623331899000},"page":"6246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Myositis\/Myasthenia after Pembrolizumab in a Bladder Cancer Patient with an Autoimmunity-Associated HLA: Immune\u2013Biological Evaluation and Case Report"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-4504","authenticated-orcid":false,"given":"Cirino","family":"Botta","sequence":"first","affiliation":[{"name":"Unit of Hematology, Azienda Ospedaliera \u201cAnnunziata\u201d, 87100 Cosenza, Italy"},{"name":"Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Maria","family":"Agostino","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Dattola","sequence":"additional","affiliation":[{"name":"Unit of Neurology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria","family":"Cianci","sequence":"additional","affiliation":[{"name":"Unit of Neurology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natale Daniele","family":"Calandruccio","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Bianco","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Mafodda","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Maisano","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Iuliano","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Orizzonte","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Mazzacuva","sequence":"additional","affiliation":[{"name":"Laboratory of Autoimmunity, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia Consuelo","family":"Falzea","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Emilena","family":"Saladino","sequence":"additional","affiliation":[{"name":"HLA Tissue Typing Laboratory, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Giannicola","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Restifo","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4574-2951","authenticated-orcid":false,"given":"Umberto","family":"Aguglia","sequence":"additional","affiliation":[{"name":"Unit of Neurology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2408-6091","authenticated-orcid":false,"given":"Michele","family":"Caraglia","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"},{"name":"Laboratory of Precision and Molecular Oncology, Biogem Scarl, Institute of Genetic Research, 83031 Ariano Irpino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2154-6734","authenticated-orcid":false,"given":"Pierpaolo","family":"Correale","sequence":"additional","affiliation":[{"name":"Unit of Oncology, Unit. Grand Metropolitan Hospital \u201cBianchi Melacrino Morelli\u201d, 89124 Reggio Calabria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/nrc3239","article-title":"The blockade of immune checkpoints in cancer immunotherapy","volume":"12","author":"Pardoll","year":"2012","journal-title":"Nat. Rev. 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