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The Hemodynamic Effects of Treatment with Interleukin-2 and Lymphokine-Activated Killer Cells

Ellen R. Gaynor, MD; Lauren Vitek, MD; Linda Sticklin, RN, MSN; Stephen P. Creekmore, MD; Mary E. Ferraro, BS; John X. Thomas Jr., PhD; Susan G. Fisher, MS; and Richard I. Fisher, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Ellen R. Gaynor, MD, Loyola University Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153.

Current Author Addresses: Drs. Gaynor, Thomas, Fisher, and Ms. Ferraro: Loyola University Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153.

Dr. Vitek, 1870 W. Dempster, Suite 410, Park Ridge, IL 60068

Dr. Creekmore, Biological Resources Branch, BRMP Frederick Cancer Research Facility, Frederick, MD 21701

Ms. Stricklin, 5200 Cleveland Street, Skokie, IL 60077

Ms. Fisher, Hines Veterans Administration Hospital, Hines, IL 60141

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(12):953-958. doi:10.7326/0003-4819-109-12-953
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Study Objective: To determine the hemodynamic alterations occurring during therapy with the maximally tolerated doses of interleukin-2 and lymphokine-activated killer cells.

Design: Case series.

Setting: Referral-based inpatient oncology service at a university medical center.

Patients: A sequential sample of 13 patients with metastatic colon carcinoma, malignant melanoma, or hypernephroma who were receiving treatment with interleukin-2 and lymphokine-activated killer cells in the maximally tolerated doses.

Measurements and Main Results: Pretreatment variables of mean arterial pressure, systemic vascular resistance, heart rate, pulmonary capillary wedge pressure, and cardiac index were compared with the same variables measured either immediately before the eighth dose of interleukin-2 or immediately before the initiation of pressor support with dopamine hydrochloride. When these values were compared with the pretreatment values, patients showed a significant decrease in mean arterial pressure (92 mm Hg compared with 75 mm Hg; P < 0.0001), and systemic vascular resistance (15.1 compared with 8.5 mm Hg/L · min; P < 0.0001), but an increase in heart rate (73 compared with 110 beats/min; P < 0.0001) and cardiac index (3.1 compared with 4.7 L/min · m2 body surface area; P < 0.0001). No significant change was noted in pulmonary capillary wedge pressure. Low systemic vascular resistance persisted throughout interleukin-2 therapy. Although blood pressure normalized in 24 hours, the systemic vascular resistance remained below baseline levels 6 days after interleukin therapy had been stopped.

Interventions: Blood pressure was successfully supported at greater than 90 mm Hg with dopamine hydrochloride or phenylephrine hydrochloride, or both.

Conclusions: Therapy with high doses of interleukin-2 induces hemodynamic changes consistent with a high-output and low-resistance state similar to changes noted during the early phase of septic shock.





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