title: Adverse effects of denileukin diftitox and their management in patients with cutaneous T-cell lymphoma.
abstract: Cutaneous T-cell lymphoma (CTCL) is a rare non-Hodgkin lymphoma with predominant skin manifestations and a relatively indolent course at early stages, but it can be fatal in advanced settings. In the absence of cure, the goal of therapy for CTCL is to induce long-term remissions without further compromising a patient's immune system or quality of life. Denileukin diftitox (DD) is a fusion protein chemotherapeutic agent used for the treatment of persistent or recurrent CTCL. It binds selectively to the high- and intermediate-affinity interleukin-2 receptor (CD25+) on lymphocytes and is internalized by these cells. Inside the cells, the diphtheria toxin portion of fusion protein is cleaved by proteolytic enzymes, causing cell death. DD produces durable responses and may forestall disease progression. This article reviews DD phase III clinical trial data and summarizes one institution's clinical experience in the management of the most frequent and clinically significant adverse effects of DD (e.g., acute infusion reactions, capillary leak syndrome, hypoalbuminemia, visual changes, constitutional symptoms, rash, hepatobiliary disorders). Many DD-associated adverse effects can be managed effectively without dose reduction or interruption of treatment with prudent use of supportive care measures.
authors.affiliation: Department of Dermatology, University of Pittsburgh, Pennsylvania, USA. mccannsa@upmc.edu
authors.forename: Sue
authors.initials: S
authors.lastname: McCann
authors.forename: Oleg E
authors.initials: OE
authors.lastname: Akilov
authors.forename: Larisa
authors.initials: L
authors.lastname: Geskin
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D004167:Diphtheria Toxin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007376:Interleukin-2 / Q000009:adverse effects* / Q000627:therapeutic use; D016399:Lymphoma, T-Cell / Q000188:drug therapy*; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D004167:Diphtheria Toxin; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins; C078456:denileukin diftitox