Transfusion-related acute lung injury (TRALI) following platelet transfusion in a patient receiving high-dose interleukin-2 for treatment of metastatic renal cell carcinoma

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Abstract

Transfusion-related acute lung injury (TRALI) is an uncommon life-threatening complication of hemotherapy. It is hypothesized to be the result of two independent insults: the first related to the clinical status of the patient and the second to the infusion of biologic response modifiers within blood components. We present a case of TRALI in a patient who received high-dose Interleukin-2 (IL-2) as treatment for metastatic renal cell carcinoma, where IL-2 is speculated to have been the first insult and transfusion of platelet concentrate the second. This is the first reported case of TRALI complicating treatment with high-dose immunotherapy.

Introduction

The transfusion of blood products is occasionally complicated by acute lung injury or adult respiratory distress syndrome (ARDS). This process is known as transfusion-related acute lung injury (TRALI) or a pulmonary leukoagglutinin reaction. Recent studies suggest that TRALI may require two sequential insults, where cytokine treatment may be the primary stimulus [1], [2]. Renal cell carcinoma (RCC) is well recognized to evoke an immune response from the host, which has occasionally resulted in spontaneous and dramatic remission [3]. In an attempt to reproduce this response, various immunotherapeutic strategies have been attempted in the treatment of RCC. In 1992, the PDA approved high-dose bolus Interleukin-2 (IL-2) for the treatment of metastatic RCC based upon data from seven phase II trials involving 255 patients [3]. We report a case of TRALI following platelets transfusion in a patient who received high-dose IL-2 treatment for metastatic RCC. This potentially life-threatening association has never been described following immunotherapy modalities.

Section snippets

Case report

The patient is a 55-year-old gentleman with RCC diagnosed in 01/2001. At the time of diagnosis, the patient was felt to have localized disease (T1N0M0, stage I) and underwent a right radical nephrectomy. Pathological specimen showed a 5.5 × 5.0 cm mass consistent with RCC, sarcomatoid and papillary types with extensive necrosis and degeneration. No evidence of extra-capsular, renal vein or lymph node involvement was noted. Routine follow up chest X-ray performed on 03/2002 showed presence of new

Discussion

The incidence of TRALI is probably underestimated since many cases may go unrecognized or may be mistaken for other causes of pulmonary edema. In different reported series, the incidence varies between 1 in 1120 and 4 in 10,000 units of cellular blood components administered [2], [4]. Recently, an epidemiological study of TRALI found that the relative prevalence of TRALI reactions being highest after transfusion of whole blood-platelets (2.4 per 1000) and lowest for plasma (1 per 19,000) [2].

Acknowledgements

The authors would like to thank the nursing staff from the department of medical oncology at the Denver Veterans Affairs Medical Center for their continuous support in the care of this patient.

References (10)

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