Pulmonary edema and shock after high-dose aracytine-C for lymphoma; possible role of TNF-alpha and PAF.
Four out of 23 consecutive patients treated with high-dose Ara-C for lymphomas in our institution developed a strikingly similar syndrome during the perfusion. It was characterized by the onset of fever, diarrhea, shock, pulmonary edema, acute renal failure, metabolic acidosis, weight gain and leukocytosis. Thorough bacteriological screening failed to provide evidence of infection. Sequential biological assays of IL-1, IL-2, TNF and PAF were performed during Ara-C infusion to ten patients, including the four who developed the syndrome. TNF and PAF activity was found in the serum of respectively two and four of the cases, but not in the six controls. As TNF and PAF are thought to be involved in the development of septic shock and adult respiratory distress syndrome, we hypothesize that high-dose Ara-C may be associated with cytokine release.
Chiche
D
D
Institut Gustave Roussy, Villejuif, France.
Pico
J L
JL
Bernaudin
J F
JF
Chouaib
S
S
Wollman
E
E
Arnoux
A
A
Denizot
Y
Y
Nitenberg
G
G
D058186:Acute Kidney Injury / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D002648:Child; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D007964:Leukocytosis / Q000139:chemically induced; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010972:Platelet Activating Factor / Q000502:physiology; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000209:etiology; D012769:Shock / Q000139:chemically induced* / Q000209:etiology; D013577:Syndrome; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D010972:Platelet Activating Factor; D014409:Tumor Necrosis Factor-alpha; D003561:Cytarabine