Adoptive chemoimmunotherapy using ex vivo activated memory T-cells and cyclophosphamide: tumor lysis syndrome of a metastatic soft tissue sarcoma.
Adoptively transferred immune cells in combination with chemotherapeutic agents form the basis for adoptive chemoimmunotherapy (ACIT) of neoplastic disease. Autolymphocytes (ALT-cells) are ex vivo activated peripheral blood lymphocytes (PBL) from tumor-bearing hosts (TBH) that consist primarily of tumor-specific CD45RO+ (memory) T-cells. These ALT-cells combined with cimetidine (CIM) as autolymphocyte therapy (ALT), have previously been demonstrated to be a safe and active form of outpatient adoptive immunotherapy (AIT) in human TBH with metastatic renal cell cancer (RCC). We have previously described an effective ACIT protocol using ALT and cyclophosphamide (CY) for patients with relapsed and refractory non-RCC solid tumors. We now report a case of a patient with a metastatic gastric leiomyosarcoma to the liver, who developed a clinical picture consistent with a tumor-lysis syndrome (TLS), following salvage therapy for his tumor with ACIT using ALT and CY. TLS is a well-known complication resulting from the treatment of rapidly proliferating hematopoietic tumors such as Burkitt's lymphoma and acute lymphocytic leukemia. TLS has also been rarely described in chronic lymphocytic leukemia, as well as certain solid tumors such as breast cancer, small cell lung cancer, and medulloblastoma. However, there have been no previous reports of TLS occurring either secondary to immunotherapy or in sarcomas. The nature of these unusual findings is discussed.
Gold
J E
JE
Department of Medicine, Mount Sinai Medical Center, New York, NY 10028.
Malamud
S C
SC
LaRosa
F
F
Osband
M E
ME
D000368:Aged; D002927:Cimetidine / Q000627:therapeutic use; D002985:Clinical Protocols; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007156:Immunologic Memory; D016219:Immunotherapy, Adoptive; D007890:Leiomyosarcoma / Q000188:drug therapy* / Q000628:therapy*; D017493:Leukocyte Common Antigens / Q000032:analysis*; D008113:Liver Neoplasms / Q000556:secondary; D008213:Lymphocyte Activation / Q000502:physiology*; D008297:Male; D011860:Radiography, Abdominal; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000628:therapy*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000628:therapy*; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D014057:Tomography, X-Ray Computed; D015275:Tumor Lysis Syndrome / Q000175:diagnosis / Q000209:etiology*
D002927:Cimetidine; D003520:Cyclophosphamide; D017493:Leukocyte Common Antigens