Capillary-leak syndrome

Cardiac arrhythmia Hypertonic crisis Pulmonary embolus Capillary leak syndrome... 

IL-2 may cause capillary leak syndrome with profound hypotension and patients may require vasopressor support and aggressive fluid management. Patients should be cared for in an intensive care setting... 

Sargramostim (GM-CSF) -hematopoietic growth factor -nausea and vomiting -flushing -capillary leak syndrome -fevers and chills -headache -bone pain -myalgias, arthralgias -leukocytosis... 

Several serious toxicities have been observed, with a fatahty rate of 5% in the initial studies. The major adverse effect is severe hypotension in as many as 85% of patients, which may lead to myocardial infarctions, pulmonary edema, and strokes. This hypotension is thought to be due to a capillary leak syndrome resulting from extravasation of plasma proteins and fluid into ex-travascular space and a loss of vascular tone. Patients with significant cardiac, pulmonary, renal, hepatic, or CNS conditions should not receive therapy with aldesleukin. Other adverse reactions include nausea and vomiting, diarrhea, stomatitis, anorexia, altered mental status, fevers, and fatigue. 

T-cell proliferation, antitumor and antimicrobial effects at high dose, it induces fever and capillary leak syndrome Proliferation of early hematopoietic cells... 

The most frequent adverse reactions associated with the administration of proleukin include fever, chills, fatigue, malaise, nausea and vomiting. It has also been associated with capillary leak syndrome (CLS). CLS is defined as a loss of vascular tone and effusion of plasma proteins and fluids into the extravascular space. This leads to hypotension and decreased organ perfusion, which may cause sudden death. Other side effects include anaphylaxis, injection site necrosis and possible autoimmune and inflammatory disorders. 

Although the two growth factors have similar effects on neutrophil counts, G-CSF is used more frequently because it is better tolerated. G-CSF can cause bone pain, which clears when the drug is discontinued. GM-CSF can cause more severe side effects, particularly at higher doses. These include fevers, malaise, arthralgias, myalgias, and a capillary leak syndrome characterized by peripheral edema and pleural or pericardial effusions. Allergic reactions may occur but are infrequent. Splenic rupture is a rare but serious complication of the use of G-CSF for PBSC. 

Therapy with IL-2 can cause severe and life-threatening toxicides that include hypotension and capillary leak syndrome [54]. Approximately 50-75% of patients receiving high-dose IL-2 experience grade 5-A hypotension requiring fluid resuscitation and pressor support Capillary leak syndrome that can result in ascites, respiratory distress, and pleural effusions has been observed in 10-20% of treated patients. Due to the toxicity profile, studies have evaluated the comparative efficacy of low-dose and high-dose IL-2 for metastatic renal cell carcinoma. 

The adverse effects of aldesleukin include fever, chills, malaise, skin rash, nausea, vomiting (often resistant to antiemetics), diarrhea, fluid retention, myalgia, insomnia, disorientation, life-threatening hypotension, and the capillary leak syndrome (which can be preceded by weight gain) (SEDA-15, 491) (2). 

A wide range of aldesleukin-induced adverse effects is associated with the capillary leak syndrome, which is characterized by an increase in vascular permeability with subsequent leakage of fluids and proteins into the extravascular space (4). This results in a third-space clinical syndrome, generalized or peripheral edema, weight gain, cardiovascular and pulmonary comphcations with hypotension, pericardial, and pleural effusions, ascites, oliguria, and prerenal azotemia. Symptoms usually resolve in a few days after aldesleukin withdrawal. Studies on the mechanism have raised a number of hypotheses, such as damage to the endothehal cells, release of secondary cytokines, and activation of the complement cascade (15). 

Railan D, Fivenson DP, Wittenberg G. Capillary leak syndrome m a patient treated with interleukin 2 fusion toxm for cutaneous T cell lymphoma. J Am Acad Dermatol 2000 43(2 Pt l) 323-4. 

Basiliximab is composed of murine sequences (30%), which can cause IgE-mediated hypersensitivity reactions. Important warnings have been released by the manufacturers regarding the possible risk of severe hypersensitivity reactions within 24 hours of initial exposure or after re-exposure after several months, based on 17 reports that included cardiac and/or respiratory failure, bronchospasm, urticaria, cytokine release syndrome, and capillary leak syndrome. 

A capillary leak syndrome with subsequent pulmonary edema has also been reported after intravenous ciclosporin (SEDA-21, 383). 

De Pas T, Curigliano G, Franceschelli L, Catania C, Spaggiari L, de Brand F. Gemcitabine-induced systemic capillary leak syndrome. Ann Oncol 2001 12(ll) 1651-2. 

Pulkkanen K, Kataja V, Johansson R. Systemic capillary leak syndrome resulting from gemcitabine treatment in renal cell carcinoma a case report. J Chemother 2003 15(3) 287-9. 

Oeda E, Shinohara K, Kamei S, Nomiyama J, Inoue H. Capillary leak syndrome likely the result of granulocyte colony-stimulating factor after high-dose chemotherapy. Intern Med 1994 33(2) 115-19. 

A rapidly reversible first-dose syndrome (dyspnea, hypoxia, tachycardia, and hypotension) can occur within the first hour after the first continuous infusion in 15-30% of patients (5). A dose-limiting vascular leak syndrome was consistently described in patients receiving GM-CSF 30 micrograms/kg/day or more, but lower doses were also reported to induce a clinically relevant capillary leak syndrome (SEDA-22, 408) (20,21). Continuation of GM-CSF treatment at the same dose or lower and careful management was possible in some patients. Endothelial cell damage with an increase in the transcapUlary escape rate of albumin and the possible role of IL-1 and TNE production by GM-CSF-activated monocjdes were... 

Arning M, Kliche KO, Schneider W. GM-CSF therapy and capillary-leak syndrome. Ann Hematol 1991 62(2-3) 83. 

Fatal capillary leak syndrome has been reported (12). 

In the light of the possible effects of interferon beta on cytokine release and complement activation, a cytokine-mediated reaction was discussed as the cause of the capillary leak syndrome in this case. 

The vascular leak syndrome was observed at a dose of 15 micrograms/kg by bolus or continuous intravenous administration, but a moderate capillary leak syndrome was also noted at lower subcutaneous doses (4). 

Two reports have recently suggested that sirolimus can produce features of the capillary leak syndrome in patients with psoriasis (10). 

Kaplan MJ, Ellis CN, Bata-Csorgo Z, Kaplan RS, Endres JL, Fox DA. Systemic toxicity following administration of sirolimus (formerly rapamycin) for psoriasis association of capillary leak syndrome with apoptosis of lesional lymphocytes. Arch Dermatol 1999 135(5) 553-7. 

Interleukin-2 (Aldesleukin, IL-2) Reversible syndrome of hypotension, oliguria, fluid retention, azotemia, and a very low urinary excretion of sodium Capillary leak syndrome Acute interstitial nephritis Steroids and plasma exchange... 

Renal toxicity has been attributed to sequelae from the development of the capillary leak syndrome. Vascular leak resulted in significant extravascular fluid accumulation (ascites, pleural effusions, peripheral edema) and weight gains of as much as 17 kg in 3 weeks [11]. As in sepsis syndrome, hypotension, oliguria and reduced fractional excretion of sodium accompanied the capillary leak. 

Interleukins are a family of cytokines, substances secreted by T-cells (lymphocytes), monocytes, macrophages, and other cells. Recombinant IL-2, known generically as aldesleukin, is effective in the therapy of a small percent of patients with renal cell carcinoma and melanoma, sometimes with very gratifying results. Its toxicity is dose-, route-, and time-dependent. At its worst, high-dose intravenous prolonged infusions cause fever, fluid retention, hypotension, respiratory distress, capillary-leak syndrome, suppression of hematopoiesis, nephrotoxicity, and hepatotoxicity. 

Fever fluid retention hypotension respiratory distress rash anemia thrombocytopenia nausea and vomiting diarrhea capillary leak syndrome nephrotoxicity myocardial toxicity hepatotoxicity erythema nodosum neutrophil chemotactic defects... 

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