癌症免疫疗法导致的肾毒性。

Nephrotoxicity from cancer immunotherapy.

作者信息

Dosik G M, Gutterman J U, Hersh E M, Akhtar M, Sonoda T, Horn R G

出版信息

Ann Intern Med. 1978 Jul;89(1):41-6. doi: 10.7326/0003-4819-89-1-41.

Abstract

Because systemic intravenous immunotherapy with Corynebacterium parvum is an effective immunopotentiating and immunotherapeutic agent in animals, clinical studies of this agent have been undertaken. Toxicities in man have been noted, but most are treated symptomatically. Three patients with metastatic melanoma developed oliguria, edema, diffuse bilateral pulmonary infiltrates, azotemia, hypoalbuminemia and hypocomplementemia, while receiving intravenous C. parvum therapy. All had renal biopsies that showed a proliferative glomerulonephritis with subendothelial basement membrane deposits. Immunofluorescence showed glomerular IgG, IgA, IgM, and the C3 component of complement. A fourth patient was found in retrospective chart review of 87 patients registered on two C. parvum-containing protcols. The frequency of the complication in this group was 3/87. Renal failure resolved in all four patients spontaneously after the cessation of C. parvum immunotherapy. Serial evaluation of renal function should be carried out in all patients on systemic adjuvant immunotherapy.

摘要

由于用短小棒状杆菌进行全身静脉免疫疗法在动物中是一种有效的免疫增强和免疫治疗剂，因此已对该制剂进行了临床研究。已注意到其在人体中的毒性，但大多数通过对症治疗。三名转移性黑色素瘤患者在接受静脉注射短小棒状杆菌治疗时出现少尿、水肿、双侧弥漫性肺部浸润、氮质血症、低白蛋白血症和补体减少。所有患者均进行了肾活检，显示为伴有内皮下基底膜沉积物的增殖性肾小球肾炎。免疫荧光显示肾小球IgG、IgA、IgM和补体C3成分。在对登记在两个含短小棒状杆菌方案中的87例患者进行回顾性病历审查时发现了第四例患者。该组并发症的发生率为3/87。在停止短小棒状杆菌免疫治疗后，所有四名患者的肾衰竭均自发缓解。对所有接受全身辅助免疫治疗的患者都应进行肾功能的系列评估。