Renal thrombotic microangiopathy associated with interferon-alpha treatment of chronic myeloid leukemia.
Recent reports have documented the development of renal thrombotic microangiopathy in patients with chronic myeloid leukemia (CML) who have undergone treatment with interferon-alpha. The pathogenesis of the renal lesion in such cases remains unclear. We report the case of a patient with chronic myeloid leukemia who developed renal failure and nephrotic syndrome while being treated with hydroxyurea and interferon-alpha. The renal biopsy showed features of chronic thrombotic microangiopathy. The patient had serologic and functional evidence of anti-phospholipid antibody. Interferon-alpha is known to cause induction of multiple autoantibodies. We propose that in the context of CML, interferon-alpha treatment can induce pathogenic anti-phospholipid antibodies that result in renal thrombotic microangiopathy. This has important implications for patients with CML receiving immune-stimulating therapy because it suggests that prospective monitoring of such patients for anti-phospholipid antibody might identify those at risk of developing thrombotic microangiopathy. Furthermore, patients with established anti-phospholipid antibody syndrome in this context might benefit from intervention such as early anticoagulation.
Magee
C C
CC
Departments of Nephrology and Pathology, Beaumont Hospital, Dublin, Ireland.
Abraham
K
K
Farrell
J
J
Dorman
T
T
Walshe
J J
JJ
D016736:Antiphospholipid Syndrome / Q000150:complications; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D007668:Kidney / Q000098:blood supply*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000188:drug therapy*; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications* / Q000209:etiology / Q000276:immunology
D016898:Interferon-alpha