Summary
A 37-year-old woman with severe aplastic anemia (SAA), who had relapsed 6 years after antilymphocyte globulin therapy, was treated with intravenous recombinant human IL-3 (4μg/kg/d) for 21 days. Subsequently, long-term therapy with subcutaneous rhIL-3 at the highest dose level tested so far (16μg/kg/kg/d) was initiated in order to maintain growth-factor response. Therapy was discontinued on day 73 due to progressive thrombocytopenia and increased petechial bleeding. Both treatment schedules resulted in a transient increase in leukocytes (twofold) due to an increase in monocytes, neutrophils, and eosinophils. RhIL-3 had no effect on hemoglobin values or platelet counts and only marginally improved colony formation of bone marrow CFU-GM in response to rhGM-CSF. Side effects of both treatment schedules were mild and did not exceed WHO grade II. Steady-state serum concentrations of IL-3, which are able to stimulate hematopoiesis in vitro (i.e.>1 ng/ml), were achieved by both low- and high-dose treatment, although high-dose treatment resulted in markedly higher serum levels of IL-3. On measuring cytokine serum levels (neopterin, IL-1β, IL-6, sIL-2R, GM-CSF, TNF-α, IFN-γ) we noticed a different cytokine pattern with both treatment modalities, resulting in a moderate induction of TNF-α and IFN-γ during low-dose, intravenous treatment, whereas during subcutaneous, high-dose treatment a profound increase of IL-6, sIL-2R, and, to a lesser extent, neopterin was detected. These results in a single patient with SAA indicate that further studies on IL-3 serum levels and IL-3-induced secondary cytokines in a larger group of patients are needed to optimize growth-factor treatment and to better understand the in vivo biological activity of IL-3.
Similar content being viewed by others
References
Camitta BM, Storb R, Thomas ED (1982) Aplastic anemia: pathogenesis, diagnosis, treatment and prognosis. N Engl J Med 306: 645–652 and 712–718
Cannistra S, Vellenga E, Groshek P, Rambaldi A, Griffin JD (1988) Human granulocyte-monocyte colony-stimulating factor and interleukin-3 stimulate monocyte cytotoxicity through a tumor necrosis factor-dependent mechanism. Blood 71: 672–676
Ganser A, Lindemann A, Seipelt G, Ottmann OG, Eder M, Falk S, Herrmann F, Kaltwasser JP, Meusers P, Klausmann M, Frisch J, Schulz G, Mertelsmann R, Hoelzer D (1990) Effects of recombinant human interleukin-3 in aplastic anemia. Blood 76: 1287–1292
Ganser A, Lindemann A, Seipelt G, Ottmann OG, Herrmann F, Eder M, Frisch J, Schulz G, Mertelsmann R, Hoelzer D (1990) Effects of recombinant human interleukin-3 in patients with normal hematopoiesis and in patients with bone marrow failure. Blood 76: 666–676
Ganser A, Seipelt G, Lindemann A, Ottmann OG, Falk S, Eder M, Herrmann F, Becher R, Höffken K, Büchner T, Klausmann M, Frisch J, Schulz G, Mertelsmann R, Hoelzer D (1990) Effects of human recombinant interleukin-3 in patients with myelodysplastic syndromes. Blood 76: 455–462
Ganser A, Lindemann A, Ottmann OG, Seipelt G, Hess U, Geissler G, Kanz L, Frisch J, Schulz G, Hermann F, Mertelsmann R, Hoelzer D (1992) Sequential in vivo treatment with two recombinant human hematopoietic growth factors (interleukin-3 and granulocyte-macrophage colony-stimulating factor) as a new therapeutic modality to stimulate hematopoiesis: results of a phase-I-study. Blood 79: 2583–2591
Geissler K, Forstinger C, Kahls P, Knöbl P, Kier P, Kyrle P, Lechner K (1992) Effect of interleukin-3 on responsiveness to granulocyte-colony-stimulating factor in severe aplastic anemia. Ann Intern Med 117: 223–225
Herrmann F, Lindemann A, Raghavachar A, Heimpel, Mertelsmann R (1990) In vivo recruitment of GM-CSF response of myelopoietic progenitor cells by interleukin-3 in aplastic anemia. Leukemia 4: 671–672
Herrmann F, Lindemann A, Lange W, Köchling G, Raghavachar A, Schrezenmeier H, Frickhofen N, Mertelsmann RH (1991) Medullary histiocytosis following treatment of severe aplastic anemia with recombinant human interleukin-3 in combination with antilymphocyte globulin, cyclosporin A and methylprednisolone. Ann Hematol 63: 229–231
Hinterberger W, Adolf G, Huber C, Köller U, Dudezak R, Knapp W, Kahls P, Geissler K, Lechner K, Volc-Platzer B (1988) Further evidence for lymphokine overproduction in severe aplastic anemia. Blood 72: 266–272
Hinterberger W, Adolf G, Bettelheim P, Geissler K, Huber Ch, Irschik E, Kahls P, Köller U, Lechner K, Meister B, Woloszczuk W (1989) Lymphokine overproduction in severe aplastic anemia is not related to blood transfusions. Blood 74: 2713–2717
Hows JM (1991) Severe aplastic anemia: the patient without a HLA-identical sibling. Br J Haematol 77: 1–4
Ikebuchi K, Wong G, Clark S, Ihle J, Hirai Y, Ogawa M (1987) Interleukin-6 enhancement of interleukin-3-dependent proliferation of multipotential hemopoietic progenitors. Proc Natl Acad Sci USA 84: 9035–9039
Ishibashi T, Kimura H, Uchida T, Kariyone S, Friese P, Burstein SA (1989) Human interleukin-6 is a direct promotor of maturation of megakaryocytes in vitro. Proc Natl Acad Sci USA 86: 5953–5956
Kurzrock R, Talpaz M, Salewski E, Guttermann JU (1990) Phase-I clinical trials with rhuIL-3. Hematopoietic growth factors — clinical update, ASH Symposium on hemopoietic growth factors. Atlanta, Georgia, pp 9–13
Kurzrock R, Talpaz M, Estrov Z, Rosenblum MG, Gutterman JU (1991) Phase-I study of recombinant human interleukin-3 in patients with bone marrow failure. J Clin Oncol 9: 1241–1250
Leary AG, Yang YC, Clark SC, Gasson JC, Golde DW, Ogawa M (1987) Recombinant gibbon interleukin-3 supports formation of human multilineage colonies and blast cell colonies in culture: comparison with recombinant human granulocytemacrophage colony-stimulating factor. Blood 70: 1343–1348
Lindemann A, Ganser A, Hermann F, Frisch J, Seipelt G, Schulz G, Hoelzer D, Mertelsmann R (1991) Biologic effects of recombinant human interleukin-3 in vivo. J Clin Oncol 9: 2120–2127
Marsh JWC, Geary CG (1991) Is aplastic anemia a pre-leukemic disorder? Br J Haematol 77: 447–452
Miura A, Endo K, Sugawara T, Kameoka JI, Watanabe N, Meguro K, Fukuhara O, Sato I, Suzuki C, Yoshinaga K (1991) T-cell-mediated inhibition of erythropoiesis in aplastic anemia: the possible role of IFN-γ and TNF-α. Br J Haematol 78: 442–449
Nissen C, Cornu P, Gratwohl A, Speck B (1980) Peripheral blood cells from patients with aplastic anaemia in partial remission suppress growth of their own bone marrow precursors in culture. Br J Haematol 45: 233–243
Nissen C, Gratwohl A, Speck B (1991) Management of aplastic anemia. Eur J Haematol 46: 193–197
Nissen-Druey C (1990) Pathophysiology of aplastic anemia. Blood Rev 4: 97–102
Rennik D, Jackson J, Yang G, Wideman J, Lee F, Hudak S (1989) Interleukin-6 interacts with interleukin-4 and other hematopoietic growth factors to selectively enhance the growth of megakaryocytic, erythroid, myeloid and multipotential progenitor cells. Blood 73: 1828–1832
Valent P, Geissler K, Sillaber C, Lechner K, Bettelheim P (1990) Why clinicians should be interested in interleukin-3. Blut 61: 338–345
Zoumbos NC, Gascon F, Djeu JY, Young N (1985) Interferon is a mediator of hematopoietic suppression in aplastic anemia in vitro and possibly in vivo. Proc Natl Acad Sci USA 82: 188–192
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nachbaur, D., Gratwohl, A., Herold, M. et al. Cytokine serum levels during treatment with high-dose recombinant human IL-3 in a patient with severe aplastic anemia. Ann Hematol 66, 71–75 (1993). https://doi.org/10.1007/BF01695887
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01695887