Interleukin 11 Induced Capillary Leakage Syndrome and Deteriorated Hemorrhagic Cystitis in an Acute Myelogenous Leukemia Patient after Allo-HSCT.

Interleukin 11 (IL11) has been approved for clinical utilization by Chinese Drug and Food Administration in the treatment of thrombopenia post chemo/radio therapy. It has been proved a safe cytokine in previous clinical trials. We however found a case who presented with a severe syndrome which was suspected in relation with IL 11. A 38- year-old male was undertaken a matched unrelated peripheral blood stem cell transplantation after an ablative BuCy conditioning for the treatment of acute myelogenous leukemia. He suffered from hemorrhagic cystitis(HC) on day 40 and was managed well with aggressive hydration and diuresis as well as administration of anti-virus regimen. After a resultant pancytopenia occurred, he was given IL11 for the amelioration of the thrombocytopenia in aid of controlling the bladder bleeding. His HC was in good control initially, but two days after the IL-11 administering, the patient manifested with generalized edema, hypotension with hemoconcentration and hypoalbuminemia without albuminuria. The diagnosis of capillary leakage syndrome (CLS) was under consideration. Interleukin 11 was ceased immediately and 6% hydroxyethly starch(HES) was added to improve the symptoms of CLS. In the following day the 24 hour- urinary volume of the patient reduced sharply accompanying by dysuresia. Ultrasonic examination displayed a clumping mass measured 50 mm×75mm ×63mm. Three days later, he was diagnosed as acute renal failure owing to combination factors of the renal and/or postrenal damage of the kidney. Meanwhile continuous renal replacement therapy (CRRT) was started and patient got well 5 days later with normal urinary volume. And symptoms from HC and CLS were improved dramatically. We concluded here that interleukin 11 could play the pivotal role in inducing a CLS and resultant acute renal failure. And it thus deteriorated HC in this patient. The patient’s renal function could recover well rapidly with the infusion of HES and CRRT. We suggested a comprehensive clinical study of Interleukin 11 be conducted to optimize its clinical usage for the sake of safe medication.