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By Anne Harding
NEW YORK, Mar 14 (Reuters Health) - In a letter to The New England Journal of Medicine, Dr. R. P. Junghans and his colleagues from Beth Israel Deaconess Medical Center in Boston, Massachusetts, report on the case of a woman who died after receiving interleukin-2 (IL-2) therapy for Hodgkin's disease.
As a result of this "catastrophic event," the authors write, other patients receiving the therapy are being followed more closely.
Certain white cells release interleukin-2, which boosts the activity of natural killer cells and other immune system components. A recombinant form of interleukin-2 has long been used in cancer therapy.
According to Junghans and colleagues, the 26-year-old woman had been undergoing interleukin-2 therapy for 27 days. She then reported 2 days of "increasing fatigue," and was found to have a very low blood pressure as well as an elevated heart rate.
Blood tests showed the woman had a high number of white blood cells called eosinophils, a condition associated with a group of heart problems known as Loffler's syndrome. These include abnormal growth of fibrous tissue in the heart and blood clots within the heart's ventricles. The syndrome can be fatal.
The interleukin-2 therapy was discontinued, but the patient died on day 29 of the therapy. An autopsy showed she had clots in the ventricles and that eosinophils had spread into the tissues of the heart.
Junghans and his colleagues then monitored the next 10 patients receiving the therapy, using echocardiography to check for symptoms of heart problems. In one of the 10 patients, they found early signs of abnormal clotting. After this patient's IL-2 therapy was discontinued, the clot disappeared and the patient's heart function improved.
"We did not want to alarm people unnecessarily, but we did want to alert clinicians to consider cardiac (blood clot) as a potential cause if symptoms seemed to warrant its investigation," Junghans told Reuters Health.
"Hodgkin's patients are a group that historically has not typically received IL-2," he continued. "Most patients receiving IL-2 have (kidney) cell cancer or melanoma because these are the best responders to IL-2 among the cancers that have been examined," he explained.
"Does this thrombosis have something to do with Hodgkin's disease? I don't know. I wish I had better answers," Junghans added.
"I would emphasize that this drug has a long history of use in many thousands of patients without this problem having occurred previously in any clinically important way. However, because this event has occurred on our particular regimen in our particular group of patients, we will continue our monitoring plan for these patients," he said.
"Our study with continuous infusion IL-2 in Hodgkin's disease is continuing (with echocardiographic monitoring) and we will be looking carefully for any correlations that might help to define predisposing factors," Junghans noted.
SOURCE: The New England Journal of Medicine 2001;344:859-860.
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