title: Interleukin-2 bolus infusion as late consolidation therapy in 2nd remission of acute myeloblastic leukemia.
abstract: The activation of autologous cytotoxic cells by interleukin-2 (IL-2) may be a promising tool for elimination of minimal residual blast populations in patients with acute myelocytic leukemia (AML) to prolong disease-free survival. Here, we report the results of a phase II study using IL-2 for consolidation therapy in patients with second remission of de novo AML. All patients in 1st relapse of AML received a uniform induction therapy consisting of intermediate high-dose AraC (iHDAraC) 2 x 600 mg/m2 d1-4 and VP-16 100 mg/m2 d1-7. Patients achieving 2nd remission were treated with 4 cycles recombinant IL-2 (rIL-2) 9 x 10(6) IU/m2 administered on d1-5 and 8-12/cycle as 1h infusion every six weeks. In 37/66 (56%) evaluable patients, complete remission (CR) was achieved. So far, 21/37 patients (4 after additional autologous bone marrow transplantation (ABMT) received rIL-2 consolidation. Three patients are too early for evaluation, 4 received allogeneic BMT, 6 relapsed before IL-2 was scheduled and 4 refused treatment with rIL-2. The median disease-free survival (DFS) was 11 (4-49+) months. Up to now, in 5/21 (24%) patients the duration of 2nd remission exceeded that of 1st remission 7/21 (33%) are in ongoing 2nd remission (7+ to 49+ months). The side effects of rIL-2 were generally moderate and manageable. Only in two patients, previously treated with ABMT, severe side effects occurred; septicaemia and pneumonia in one patient and desquamative erythrodermia in the second one. In accordance with other studies rebound lymphocytosis with a marked increase of CD56(+)-cells and release of secondary cytokines such as TNF-alpha, IFN-gamma and IL-6 was observed. The schedule is feasible and the data suggest a possible benefit for DFS, which, however has to be confirmed by randomized trials.
authors.affiliation: Department of Internal Medicine, J.W. Goethe University, Frankfurt; Federal Republic of Germany.
authors.forename: L
authors.initials: L
authors.lastname: Bergmann
authors.forename: G
authors.initials: G
authors.lastname: Heil
authors.forename: K
authors.initials: K
authors.lastname: Kolbe
authors.forename: E
authors.initials: E
authors.lastname: Lengfelder
authors.forename: E
authors.initials: E
authors.lastname: Puzicha
authors.forename: H
authors.initials: H
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Lohmeyer
authors.forename: P S
authors.initials: PS
authors.lastname: Mitrou
authors.forename: D
authors.initials: D
authors.lastname: Hoelzer
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D016207:Cytokines / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007376:Interleukin-2 / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008214:Lymphocytes / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology; D012074:Remission Induction
chemical_list: D016207:Cytokines; D007376:Interleukin-2; D011994:Recombinant Proteins