Adoptive chemoimmunotherapy using Ex vivo activated memory T‐cells and cyclophosphamide: Tumor lysis syndrome of a metastatic soft tissue sarcoma

Abstract

Adoptively transferred immune cells in combination with chemotherapeutic agents form the basis for adoptive chemoimmunotherapy (ACIT) of neoplastic disease. Autolymphocytes (ALT-cells) are ex vivo activated peripheral blood lymphocytes (PBL) from tumor-bearing hosts (TBH) that consist primarily of tumor-specific CD45RO+ (memory) T-cells. These ALT-cells combined with cimetidine (CIM) as autolymphocyte therapy (ALT), have previously been demonstrated to be a safe and active form of outpatient adoptive immunotherapy (AIT) in human TBH with metastatic renal cell cancer (RCC). We have previously described an effective ACIT protocol using ALT and cyclophosphamide (CY) for patients with relapsed and refractory non-RCC solid tumors. We now report a case of a patient with a metastatic gastric leiomyosarcoma to the liver, who developed a clinical picture consistent with a tumor-lysis syndrome (TLS), following salvage therapy for his tumor with ACIT using ALT and CY. TLS is a well-known complication resulting from the treatment of rapidly proliferating hematopoietic tumors such as Burkitt's lymphoma and acute lymphocytic leukemia. TLS has also been rarely described in chronic lymphocytic leukemia, as well as certain solid tumors such as breast cancer, small cell lung cancer, and medulloblastoma. However, there have been no previous reports of TLS occurring either secondary to immunotherapy or in sarcomas. The nature of these unusual findings is discussed.

Tumor Lysis Syndrome in Solid Tumors: An up to Date Review of the Literature

“…All of the patients had evidence of advanced and metastatic disease. One patient was reported to have normal baseline laboratory values, 111 one had elevated baseline values of creatinine and phosphorus, 112 and another one had baseline values for elevated levels LDH. 113 Three cases were associated with preceding chemotherapy.…”

An Unusual Presentation of Tumor Lysis Syndrome in a Patient with Advanced Gastric Adenocarcinoma: Case Report and Literature Review

“…According to the literature review, there have been 100 reported cases of TLS in patients with solid tumors from the first report in 1977 to 2011 (Table 1) (Figure 2), including small cell carcinomas [9, 20–30], squamous cell carcinomas [10, 11], adenocarcinomas of the lung [12, 31–33], mixed small cell and nonsmall cell lung carcinoma [34], gastrointestinal carcinomas [13–15, 35–42], hepatoblastomas [43, 44], hepatocellular carcinomas [15, 45–53], renal carcinomas [54–56], transitional cell carcinoma [57], prostate carcinomas [58–61], breast carcinomas [16, 30, 62–68], ovarian carcinomas [69, 70], endometrial carcinoma [71], vulva carcinomas [72, 73], thymomas [74, 75], melanomas [76–82], gestational trophoblastic neoplasia [83], germ cell tumors [17, 18, 64, 84, 85], neuroblastomas [86, 87], medulloblastomas [88, 89], and sarcomas [19, 90–93]. Most cases regarded as TLS in solid tumors were chemotherapy-induced, even though various other causes were pointed out for TLS in solid tumors as well [3] (Table 1) (Figure 1).…”

Tumor lysis without syndrome in adenocarcinoma of the lung: Case report

“…Solid tumors that are known to cause TLS include breast carcinoma [3], medullo-blastoma [4], ovarian cancer [5], rhabdomyosarcoma [6] and neuro-blastoma [7]. Typically these tumors are bulky with multiple metastatic foci and generally are sensitive to initial chemotherapy.…”