Blood, 15 March 2001, Vol. 97, No. 6, pp. 1523-1523
Foiling IL-6 to treat B-lymphoproliferative disorder
Approximately 21 000 solid organ transplantations are
performed annually in the United States. These transplantations offer hope to those about to die of a failing heart, a hepatitis C-ravaged liver, or severe chronic obstructive pulmonary disease, or they improve
the quality of life for those on chronic dialysis. But the dark side of
solid organ transplantation is the need for long-term immunosuppression
to prevent organ rejection. This results in a substantial risk of
Epstein-Barr virus-driven B-lymphoproliferative disorder (BLPD),
ranging from approximately 1% in kidney-transplant recipients to 5%
in heart-transplant recipients, and possibly higher in lung-transplant
recipients. Treatment of BLPD has been challenging. Unlike patients
with other types of aggressive non-Hodgkin lymphoma, patients with BLPD
can be cured by resection of localized disease (often pulmonary
nodules). Interferon alpha, multiagent systemic chemotherapy, or
rituximab can also be curative. Haddad and colleagues (page 1590) used
the observation that IL-6 is a growth factor for EBV-infected B
lymphocytes to design a novel treatment approach for these patients.
They treated 12 solid organ-transplant recipients who developed BLPD,
with an anti-IL-6 monoclonal antibody. After daily injections of the
anti-IL-6 monoclonal antibody for 15 days, 5 patients achieved a
complete response and 3 patients achieved a partial response. No major
toxicity was observed, and the remissions were durable in most
patients. How will anti-IL-6 therapy fit into the panoply of
treatments for B-lymphoproliferative disorder? This will require
further study and larger numbers of patients.
Virginia C. Broudy
University of Washington
