Nephrotic syndrome during treatment with interferon

A case of fatal pemphigus vulgaris in association with beta interferon and interleukin-2 therapy

Beta interferon (beta-IFN) and interleukin-2 (IL-2) have been utilized in experimental cancer therapy because of their effects on the immune system. We report here a patient treated with IL-2 and beta-IFN who rapidly developed an immune-mediated, bullous exfoliative dermatitis and who ultimately died. Various etiologic mechanisms are proposed.

The role of interferons in the treatment of malignant neoplasms

Interferons (IFNs) are proteins with a wide range of biological effects. IFNs have antiviral and antiproliferative properties. They modulate both the immune system and the expression of cell phenotype. In the past decade, the IFNs have received intense clinical scrutiny. Alpha IFN is the best studied and displays activity in many neoplastic diseases; it has shown the most promise in the hematological cancers although several solid tumors, including epidemic Kaposi's sarcoma, renal cell carcinoma, and melanoma, respond. No neoplastic disease, however, has been cured by the IFNs. IFN seems to be most active in the setting of minimal residual disease, and clinical studies evaluating its role in the adjuvant setting are under way. Other areas of research include trials combining IFN with cytotoxic drugs or other biological response modifiers, and maintenance IFN to prolong remissions following successful induction therapy.

Interferons: biological and clinical effects

Interferons play a key role in the immune system as biological response modifiers. Interferons alpha, beta, and gamma have been characterized, their nucleotide sequences defined, and the proteins produced by recombinant DNA technology. The myriad actions of interferons include enhancement of natural killer cell activity and antigen expression, induction of varied proteins, activation of macrophages, and antiviral, antiproliferative and antitumor effects. Clinical trials have demonstrated efficacy of interferons in some malignancies and ongoing studies are investigating results of combinations with other biological response modifiers and cytotoxic agents.

[Detection of nephrotoxicity of human alpha 2b interferon with special reference to the analysis of urine enzymes in patients with chronic myeloid leukemia]

The nephrotoxic potential of alpha-interferon (IFN alpha-2b) was analysed in 21 patients with chronic myeloid leukemia. As particularly sensitive parameters in the detection of subclinical renal injury we measured the excretion of the following urinary enzymes: lactate dehydrogenase (LDH), gamma-glutamyltransferase (GGT), leucine arylaminidase (LAP), beta-galactosidase (GAL) and N-acetyl-beta-glucosaminidase (NAG). Additionally, protein excretion and urinary sediment were analysed. In 18 of 21 patients a significant increase in the excretion of LDH, LAP, GGT and NAG was found, in 6 patients there was an additional rise in the output of GAL. Eleven patients developed proteinuria up to 2 g/l, one patient excreted up to 9 g/l. Enzymuria and protein excretion decreased in all patients after reduction of the IFN alpha-2b dosage and disappeared in two patients following cessation of therapy. The high incidence of nephrotoxic events in patients with CML during IFN alpha-2b therapy might be mostly due to immunological or substance-specific effects.