OK-432 THERAPY FOR LYMPHANGIOMA IN CHILDREN - WHY AND HOW DOES IT WORK

Intralesional injection of OK-432 (lyophilized incubation mixture of g roup A Streptococcus pyogenes of human origin) is safe and effective t herapy for lymphangioma. The authors evaluated the mechanism of this t herapy in 6 patients who had cystic lymphangioma. The intracystic flui d of the cystic lymphangioma was aspirated before and after (on days 1 and 4) the OK-432 therapy. Changes in cell populations and cytokine p roductions in each aspirated fluid were analyzed. White blood cells in the intracystic fluid increased markedly in number. Before OK-432 the rapy, 96% of the intracystic white blood cells were lymphocytes, and t he remaining were neutrophils and macrophages, On day 1, the percentag es of neutrophils and macrophages increased to 72% and 21%, respective ly. On day 4, the percentage of lymphocytes increased to 72%. Flow cyt ometry analysis using monoclonal antibodies showed that the number of natural killer cells (CD56(+)) and T cells (CD3(+)) had increased. The activity of cytotoxic tumor necrosis factor (TNF) and interleukin-6 i ncreased immediately after OK-432 injection and remained high in titer until day 4, These findings suggest that the white blood cells induce d and activated by OK-432, and the cytokines (including TNF) produced by these cells increased the endothelial permeability, and thus the ac celerated lymph drainage and increased lymph flow led to shrinkage of the cystic spaces. (C) 1996 by W.B. Saunders Company