Journal of Clinical Oncology, Vol 11, 1817-1825, Copyright © 1993 by American Society of Clinical Oncology
Does interleukin-2 have a role in the management of acute leukemia?
R Foa
Dipartimento di Scienze Biomediche e Oncologia Umana, Sezione di Clinica Medica, Torino, Italy.
PURPOSE: To discuss the possibility that interleukin-2 (IL-2)-based
immunotherapeutic protocols may have a role in the management of acute
leukemia. DESIGN: The preclinical results that have led to the clinical use
of IL-2 in acute leukemia will be reviewed. The clinical data obtained with
the administration of IL-2 to acute leukemia patients in different phases
of their disease will be discussed, together with the clinicohematologic
and immunologic modifications induced following the infusion of IL-2.
Finally, the possibility that limitations associated with the exogenous
administration of high-dose IL-2 may be circumvented by engineering
techniques aimed at inserting the IL-2 gene directly into the tumor cells,
will be addressed. RESULTS: The data indicate that high-dose IL-2 may be
administered to acute leukemia patients. Toxicity, recorded in all
patients, appears to be controllable using a continuous intravenous (i.v.)
infusion protocol based on a daily dose- escalating administration.
Complete remissions have been documented in acute myeloid leukemias (AMLs)
with a limited, but detectable proportion of residual marrow blasts.
Numerous phenotypic and functional changes have been recorded within the
immune system of the host. Using retroviral vectors, the IL-2 gene may be
productively transduced into human acute leukemia cell lines. CONCLUSION:
IL-2 appears to represent a therapeutic option for AML patients with
limited/minimal residual disease. The results of the ongoing randomized
trials in patients in first or second remission are awaited.
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