Interferon–Alpha-2a for the Treatment of Complex Hemangiomas of Infancy and Childhood

Abstract

ObjectiveThe authors describe the use of interferon-alpha-2a in the treatment of complex hemangiomas and review the role of interferon (IFN) in this example of an angiogenic disease. Summary Background DataHemangiomas are the most frequent tumors of infants and children. They grow rapidly for 6 to 8 months and then resolve over a period of years. Approximately 5% produce life-, sight-, or limbthreatening complications, with mortality rates between 20% and 50%. Aggressive therapy with steroids, arterial ligation or embolization, or surgery has been used in these situations with variable results and high morbidity. Recently, IFN-a was found to be effective treatment in these complex hemangiomas. MethodsFour infants and one child were treated with IFN-a-2a at an initial subcutaneous dose of 1 million units/m2/day and a sustained dose of 3 million units/m2/day for 5 to 11 months. Appropriate laboratory values were monitored and adverse reactions and ultimate response to therapy were recorded. ResultsTwo patients experienced minor complications that were managed easily. Three patients had total or near-total regression of the hemangioma, one had partial (50%) regression, and one had stabilization but no regression after an average of 7.1 months of IFN therapy.

Antenatal ultrasonographic features of fetal giant hemangiolymphangioma

“…This syndrome has a similar ultrasonographic appearance to the vascular lesions with hemangiolymphangioma 14,15 , but the latter is not associated with asymmetric limb hypertrophy. Hemangiolymphangioma can now be treated effectively by OK-432 and interferon-alfa-2a [5][6][7][8][9][10] . Ogita et al 6 suggested that the intratumoral injection of OK-432 induces and activates white blood cells, and elevated cytokines (including tumor necrosis factor) increase the endothelial permeability.…”

“…The accelerated lymph drainage and increased lymph flows lead to shrinkage of the cystic spaces. Ricketts et al 8 demonstrated that interferon-alfa inhibits angiogenesis, and endothelial cell migration and proliferation.…”

“…Postnatal treatment requires extensive excision of the lesion 3,4 but recently the condition has been treated effectively by chemotherapy, involving the administration of OK-432 (host-immunoactivator: Picibanil R) for the lymphangioma and interferonalfa-2a for the hemangioma [5][6][7][8][9][10] . We present a case of giant hemangiolymphangioma diagnosed antenatally using color and pulsed Doppler ultrasound.…”

Treatment of lymphangioma with interferon-alpha-2a

“…O alfa-2a-interferon tem sido utilizado com ótimos resultados no tratamento dos hemangiomas 7,[10][11][12][13][14][15] . Isso levou Reinhardt e cols.…”

“…Estudos in vivo, em modelos animais, com linfócitos e angiogênese induzida por células tumorais, o a-2a-INF demonstrou também atuar indiretamente, inibindo o estímulo angiogênico, através da inibição dos efeitos de fatores de crescimento específicos sobre a proliferação de células endoteliais 12,13 .…”