Bilateral adrenal hemorrhage and adrenal insufficiency in a patient with lymphomatous adrenal infiltration following administration of a fusion toxin (DAB486 interleukin-2).
DAB486IL-2 is a novel fusion toxin in which the ADP-ribosyltransferase and membrane-translocating domains of diphtheria toxin have been combined with the interleukin-2 (IL-2) gene, creating a recombinant protein capable of selectively intoxicating cells bearing the high-affinity IL-2 receptor. Clinical activity has been documented in Hodgkin disease and the non-Hodgkin lymphomas; toxicities have been minimal and include mild hepatic transaminitis, proteinuria, and hypersensitivity reactions. In this report, a patient with tumor-stage cutaneous T-cell lymphoma developed clinical adrenal failure with bilateral adrenal hemorrhage and necrosis 7 weeks after completing a 5-day course of treatment with DAB486IL-2. The relationship of fusion toxin therapy to the development of this unusual toxicity is discussed.
Cohen
R
R
National Cancer Institute-Navy Medical Oncology Branch, Bethesda, Maryland.
Jaffe
E S
ES
Stetler-Stevenson
M A
MA
Sausville
E A
EA
DeNigris
E C
EC
Woodworth
T
T
Foss
F M
FM
D000307:Adrenal Gland Diseases / Q000209:etiology* / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000628:therapy; D000309:Adrenal Insufficiency / Q000209:etiology; D000368:Aged; D004167:Diphtheria Toxin / Q000009:adverse effects* / Q000494:pharmacology*; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D000922:Immunotoxins / Q000009:adverse effects* / Q000627:therapeutic use; D007376:Interleukin-2 / Q000009:adverse effects* / Q000494:pharmacology*; D016410:Lymphoma, T-Cell, Cutaneous / Q000473:pathology / Q000628:therapy; D008297:Male; D009336:Necrosis / Q000209:etiology; D009361:Neoplasm Invasiveness; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use
C054780:DAB(486)-interleukin 2; D004167:Diphtheria Toxin; D000922:Immunotoxins; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins