A prospective randomized trial evaluating colloid versus crystalloid resuscitation in the treatment of the vascular leak syndrome associated with interleukin-2 therapy.
Interleukin-2 (IL-2)-based therapy induces a vascular leak syndrome (VLS), manifested by hypotension, tachycardia, and oliguria, as is also seen with septic shock. The optimal method for treating such VLS is not known. A prospective randomized trial was undertaken to compare crystalloid and colloid fluid resuscitation for patients receiving bolus IL-2-based therapy for metastatic cancer. All patients received maintenance crystalloid fluid administration and were randomized to receive crystalloid (0.9% normal saline) or colloid (5% human serum albumin) fluid boluses to maintain acceptable vital signs and urine output. Patients refractory to fluid boluses were given dopamine for oliguria and/or phenylephrine for hypotension. Of 107 patients who completed one cycle of therapy on study, 76 completed a full treatment course (two cycles) on study. The total number of saline and albumin fluid boluses given were 9.5 +/- 0.9 versus 7.7 +/- 0.7 (p = 0.36, n = 107) for the first cycle and 19.2 +/- 1.8 versus 16.1 +/- 1.6 (p = 0.33, n = 76) for a complete course, respectively. Although patients receiving saline boluses had significantly more oliguria during a course of therapy, weight gain, number of IL-2 doses, tachycardia, hypotension, vasopressor use, hospital stay, and clinical response rates did not significantly differ between arms. Changes in hematocrit, hemoglobin, protein, albumin, blood urea nitrogen (BUN), and creatinine were analyzed, and patients receiving crystalloid showed greater decreases in albumin (p < 0.0001) and total protein (p < 0.05) as expected. A 40-fold greater cost associated with albumin suggested that crystalloid resuscitation be used to treat the VLS associated with IL-2 therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Pockaj
B A
BA
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892.
Yang
J C
JC
Lotze
M T
MT
Lange
J R
JR
Spencer
W F
WF
Steinberg
S M
SM
Topalian
S L
SL
Schwartzentruber
D J
DJ
White
D E
DE
Rosenberg
S A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy*; D007376:Interleukin-2 / Q000009:adverse effects*; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000209:etiology / Q000628:therapy*; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies; D012151:Resuscitation; D013577:Syndrome; D013610:Tachycardia / Q000209:etiology / Q000628:therapy*
D003102:Colloids; D000077324:Crystalloid Solutions; D007376:Interleukin-2; D007552:Isotonic Solutions; D010952:Plasma Substitutes