CHARACTERIZATION OF CANCER-RELATED DISSEMINATED INTRAVASCULAR COAGULATION IN RELATION TO TUMOR-NECROSIS-FACTOR-ALPHA BLOOD-CONCENTRATIONS -POSSIBLE THERAPEUTIC ROLE OF PENTOXIFYLLINE

Aims and Background: Preliminary experimental data suggest the involve ment of tumor necrosis factor (TNF) in determining endothelial damage related to disseminated intravascular coagulation (DIG), The present s tudy was performed to investigate TNF secretion in DIC occurring in me tastatic solid tumor patients and to evaluate the possible therapeutic role of pentoxifylline, which has been proven to have a TNF-lowering activity. Methods: The study included 20 metastatic solid tumor patien ts who showed clinical and laboratory signs of DIG. Pentoxifylline was given orally at a dose of 1200-mg/day for 28 days. Results: Abnormall y high levels of TNF were found in 13/20 patients, and mean TNF serum levels observed in patients were significantly higher than those seen in a control group of 50 healthy subjects. Fibrinogen plasma concentra tions were low in 11 cases, Patients with low fibrinogen values showed significantly higher mean TNF levels than those with normal or elevat ed concentrations. Pentoxifylline therapy induced a significant decrea se in mean TNF concentrations and a significant increase in mean plate let number, which returned to within the normal range in 11/20 patient s, An increase in platelets in response to pentoxifylline was more evi dent in patients with elevated pretreatment TNF values, Conclusions: O ur results suggest the existence of abnormally high blood levels of TN F in cancer-related DIG, mainly in the presence of low fibrinogen valu es. Moreover, they indicate that pentoxifylline therapy may determine a decrease in TNF levels in DIC patients, an event associated with an increase in platelet number.