PULMONARY-EDEMA AND SHOCK AFTER HIGH-DOSE ARACYTINE-C FOR LYMPHOMA - POSSIBLE ROLE OF TNF-ALPHA AND PAF

Four out of 23 consecutive patients treated with high-dose Ara-C for l ymphomas in our institution developed a strikingly similar syndrome du ring the perfusion. It was characterized by the onset of fever, diarrh ea, shock, pulmonary edema, acute renal failure, metabolic acidosis, w eight gain and leukocytosis. Thorough bacteriological screening failed to provide evidence of infection. Sequential biological assays of IL- 1, IL-2, TNF and PAF were performed during Ara-C infusion to ten patie nts, including the four who developed the syndrome. TNF and PAF activi ty was found in the serum of respectively two and four of the cases, b ut not in the six controls. As TNF and PAF are thought to be involved in the development of septic shock and adult respiratory distress synd rome, we hypothesize that high-dose Ara-C may be associated with cytok ine release.