CARDIORESPIRATORY EFFECTS OF IMMUNOTHERAPY WITH INTERLEUKIN-2
CARDIORESPIRATORY EFFECTS OF IMMUNOTHERAPY WITH INTERLEUKIN-2
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DOI：
10.1200/jco.1989.7.1.7
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发表时间：
1989-01-01
影响因子：
45.3
通讯作者：
ROSENBERG, SA
中科院分区：
文献类型：
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作者：
LEE, RE;LOTZE, MT;ROSENBERG, SA
白细胞介素 2 (IL-2) 和淋巴因子激活杀伤 (LAK) 细胞的施用可以介导癌症的消退。 IL-2 治疗与显着的心肺作用以及需要仔细液体管理的毛细血管渗漏综合征相关。 IL-2 治疗也与心脏功能的轻度可逆性抑制有关。 1984 年 12 月至 1987 年 9 月期间，对所有单独使用重组 IL-2、LAK 细胞转移或环磷酰胺治疗的患者（总共 317 名患者进行了 423 个治疗疗程）进行了评估，以评估是否发生显着的心肺毒性。在 423 个疗程中，只有 1.8% 与严重外周水肿相关，只有 2.8% 和 3.1% 分别与显着腹水或胸腔积液相关。 423 名患者中有 39 名 (9.2%) 出现严重呼吸窘迫，27 名患者 (6.4%) 需要插管。心血管效应包括心动过速和低血压，65% 需要血管加压药和静脉 (IV) 输液。体重增加.gtoreq. 423 名患者中，有 32% 的患者体重减轻了 10%。心律失常主要是室上性心律失常（9.7%），对传统药物治疗反应良好。 2.6% 的患者出现心绞痛或缺血性变化，1.2% 的患者出现心肌梗塞。 IL-2 引起外周血管舒张，外周血管阻力显着降低 (2,254 .+-. 398 v 1,303 .+-. 351 dyne .cntdot. s .cntdot. cm-5，P < .0001)，心率增加 (66.2 .+-. 10 v 104.3 .+-. 9.6节拍/分钟，P < .0001)。还有轻度心脏功能障碍的证据，左心室每搏功 (LVSW) 指数 (P < .0001) 和射血分数 (LVEF) 显着下降（从 58% .+-. 10% 降至 52% .+-. 9.%，P < .03）。 1 至 3 个月后重复 LVEF，已恢复至基线值 (60% .+-. 10%)。放射性碘 (125I) 白蛋白消失率平均增加 64% (P < .05)，与毛细血管渗漏综合征的发展一致。患有基础心肺疾病的患者在IL-2给药期间可能面临更大的风险，不应选择接受这种治疗。
The administration of interleukin 2 (IL-2) and lymphokine-activated killer (LAK) cells can mediate the regression of cancer. Treatment with IL-2 is associated with significant cardiorespiratory effects, as well as a leaky capillary syndrome requiring careful fluid management. A mild reversible depression of cardiac function is also associated with IL-2 treatment. All patients treated with recombinant IL-2 alone, with transfer of LAK cells, or with cyclophosphamide between December 1984 and September 1987 (total of 423 treatment courses in 317 total patients) were evaluated as to the development of significant cardiorespiratory toxicity. Of the 423 treatment courses, only 1.8% were associated with severe peripheral edema and only 2.8% and 3.1%, respectively, were associated with significant ascites or pleural effusions. Thirty-nine of 423 patients (9.2%) had severe respiratory distress and 27 patients required intubation (6.4%). Cardiovascular effects included tachycardia and hypotension requiring vasopressor administration in 65.% and intravenous (IV) fluid administration. Weight gain .gtoreq. 10% of body weight was noted in 32% of the 423 patients. Arrhythmias were primarily supraventricular (9.7%) and responded well to conventional medical treatments. Angina or ischemic changes were noted in 2.6% of patients and myocardial infarction in 1.2%. IL-2 caused peripheral vasodilation, with a significant decrease in peripheral vascular resistance (2,254 .+-. 398 v 1,303 .+-. 351 dyne .cntdot. s .cntdot. cm-5, P < .0001), and an increase in heart rate (66.2 .+-. 10 v 104.3 .+-. 9.6 beats/min, P < .0001). There was also evidence of mild cardiac dysfunction, with a significant decrease in the left ventricular stroke work (LVSW) index (P < .0001) and ejection fraction (LVEF) (from 58% .+-. 10% to 52% .+-. 9.%, P < .03). A repeat LVEF performed after 1 to 3 months, had returned to baseline values (60% .+-. 10%). A mean 64% increase in the rate of disappearance of radioactive iodine (125I) albumin (P < .05) consistent with the development of a leaky capillary syndrome was noted. Patients with underlying cardiorespiratory diseases may be at greater risk during IL-2 administration and should not be selected to undergo this treatment.