Severe reversible global and regional ventricular dysfunction associated with high-dose interleukin-2 immunotherapy.
Cardiac toxicity and hemodynamic alterations are frequently associated with high-dose interleukin-2 (IL-2) immunotherapy in cancer patients. Serious cardiac events including myocardial infarction, ischemia, and noninfectious myocarditis have been observed. We document two cases of unusually severe but reversible cardiac abnormalities related to IL-2 therapy: one patient with a profound form of global myocardial hypocontractility and a second patient with regional aneurysmal and dyskinetic changes of the left ventricle. These cases exhibit unique features not previously described in IL-2-treated patients. The possible pathophysiologic mechanisms underlying these global and regional forms of cardiomyopathy, including the production of secondary-messenger molecules such as nitric oxide and myocardial stunning, are discussed. Both patients remain disease free of their cancer (> 3 years since completing therapy), are without residual cardiac dysfunction or recurrent related symptoms, and have not experienced any additional cardiac events. The report demonstrates the complexity of the cardiac toxicities associated with IL-2-based immunotherapy and recognizes a need for treating physicians to be familiar with their management.
Du Bois
J S
JS
Division of Hematology/Oncology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Udelson
J E
JE
Atkins
M B
MB
D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000009:adverse effects*; D008545:Melanoma / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000503:physiopathology
D007376:Interleukin-2