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High-dose tumor necrosis factor-alpha leads to the systemic inflammatory response syndrome

      Tumor necrosis factor-alpha (TNF-alpha) has been implicated in the pathophysiology of the systemic inflammatory response syndrome (
      • Dinarello C.A
      • Gelfand J.A
      • Wolff S.M
      Anticytokine strategies in the treatment of the systemic inflammatory response syndrome.
      ,
      • Davies M.G
      • Hagen P.-O
      Systemic inflammatory response syndrome.
      ). This syndrome is often associated with acute hepatic failure, in which TNF-alpha has also been reported to play a central role (
      • Wang J.H
      • Redmond H.P
      • Watson R.W
      • Bouchier-Hayes D
      Role of lipopolysaccharide and tumor necrosis factor-alpha in induction of hepatocyte necrosis.
      ). The systemic use of TNF-alpha in cancer patients is limited by the high incidence of side effects, whereas the therapeutic effect of acceptable doses remains poor (
      • Frei E
      • Spriggs D
      Tumor necrosis factor still a promising agent.
      ). Only with TNF-alpha perfusion of isolated limbs is there both a good tumor response and tolerable systemic side effects after intensive wash-out of the TNF-alpha (
      • Eggermont A.M.M
      • Koops H.S
      • Klausner J.M
      • et al.
      Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas.
      ). Isolated liver perfusion with TNF-alpha is under investigation for the treatment of unresectable liver tumors (
      • Fraker D.L
      • Alexander H.R
      • Thom A.K
      Use of tumor necrosis factor in isolated hepatic perfusion.
      ). Eight isolated liver perfusions with TNF-alpha have been performed at our institution. We describe our experience with a unique case of accidental high TNF-alpha release into the systemic circulation after insufficient wash-out.
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      References

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