Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin-2 immunotherapy: A case report

Cristina I. Truica, Christian H. Hansen, David F. Garvin, Kenneth R. Meehan

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Interleukin-2 (IL-2) is used in the treatment of solid tumors and hematologic malignancies. Sudden death is a rare complication of IL-2 treatment. METHODS. A patient with lymphoma underwent chemoradiotherapy myeloablation and autologous stem cell transplantation. The stem cells were cultured in IL-2 (6000 IU/mL) for 24 hours prior to infusion. After engraftment, treatment with IL-2 (1.8 x 106 IU/m2/day administered subcutaneously) was begun. After 4 days of treatment, the patient suddenly died. An autopsy was performed. RESULTS. Histologic examination of the myocardium revealed a diffuse, lymphocytic infiltrate with scattered, multinucleated giant cells and loci of myocardial degeneration consistent with giant cell myocarditis. The lymphocytes were predominantly CD4 positive T cells, and the majority of these cells stained with antibodies for perforin, suggesting an unusual cytolytic role for these lymphocytes. DNA end-labeling of myocardial tissue sections revealed numerous apoptotic myocytes within the lymphocytic infiltrate. CONCLUSIONS. To the authors' knowledge, this is the first report of giant cell myocarditis in association with high dose chemotherapy, transplantation, and IL-2 immunomodulation. The authors suggest that the cytokine imbalance produced by IL-2 may have initiated a preferential activation of T helper cells and an autoimmune phenomenon manifesting as giant cell myocarditis.

Original languageEnglish (US)
Pages (from-to)1231-1236
Number of pages6
JournalCancer
Volume83
Issue number6
DOIs
StatePublished - Sep 15 1998
Externally publishedYes

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Hematopoietic Stem Cell Transplantation
Myocarditis
Giant Cells
Immunotherapy
Interleukin-2
Lymphocytes
Perforin
Immunomodulation
Stem Cell Transplantation
Chemoradiotherapy
Hematologic Neoplasms
Therapeutics
Helper-Inducer T-Lymphocytes
Sudden Death
Muscle Cells
Autopsy
Lymphoma
Myocardium
Stem Cells
Transplantation

Keywords

  • Giant cell myocarditis
  • Interleukin-2
  • Stem cell transplantation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin-2 immunotherapy : A case report. / Truica, Cristina I.; Hansen, Christian H.; Garvin, David F.; Meehan, Kenneth R.

In: Cancer, Vol. 83, No. 6, 15.09.1998, p. 1231-1236.

Research output: Contribution to journalArticle

Truica, Cristina I. ; Hansen, Christian H. ; Garvin, David F. ; Meehan, Kenneth R. / Idiopathic giant cell myocarditis after autologous hematopoietic stem cell transplantation and interleukin-2 immunotherapy : A case report. In: Cancer. 1998 ; Vol. 83, No. 6. pp. 1231-1236.
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AB - BACKGROUND. Interleukin-2 (IL-2) is used in the treatment of solid tumors and hematologic malignancies. Sudden death is a rare complication of IL-2 treatment. METHODS. A patient with lymphoma underwent chemoradiotherapy myeloablation and autologous stem cell transplantation. The stem cells were cultured in IL-2 (6000 IU/mL) for 24 hours prior to infusion. After engraftment, treatment with IL-2 (1.8 x 106 IU/m2/day administered subcutaneously) was begun. After 4 days of treatment, the patient suddenly died. An autopsy was performed. RESULTS. Histologic examination of the myocardium revealed a diffuse, lymphocytic infiltrate with scattered, multinucleated giant cells and loci of myocardial degeneration consistent with giant cell myocarditis. The lymphocytes were predominantly CD4 positive T cells, and the majority of these cells stained with antibodies for perforin, suggesting an unusual cytolytic role for these lymphocytes. DNA end-labeling of myocardial tissue sections revealed numerous apoptotic myocytes within the lymphocytic infiltrate. CONCLUSIONS. To the authors' knowledge, this is the first report of giant cell myocarditis in association with high dose chemotherapy, transplantation, and IL-2 immunomodulation. The authors suggest that the cytokine imbalance produced by IL-2 may have initiated a preferential activation of T helper cells and an autoimmune phenomenon manifesting as giant cell myocarditis.

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