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Cardiac effects of prolonged recombinant human interleukin-11 treatment in severe thrombocytopenia: a retrospective
Xian-Fa Li1, Yue Sun2, Wen-Rong Wang3
1Department of Nephrology (Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road 453, Hangzhou, Zhejiang Province, 310007, China. lixianfa025@163.com.
Background:
Recombinant human interleukin-11 (rhIL-11) is commonly used to treat thrombocytopenia induced by cancer chemotherapy. However, concerns about its potential cardiac side effects, especially with prolonged use, warrant further investigation.
Aim:
This study aimed to evaluate the cardiac effects of prolonged rhIL-11 use by comparing changes in cardiac biomarkers and arrhythmia rates between rhIL-11 and recombinant human thrombopoietin (rhTPO) in patients with severe thrombocytopenia.
Method:
We conducted a retrospective cohort study of adult patients treated with rhIL-11 or rhTPO for ≥ 5 days between 2015 and 2021. Data were collected at baseline, during treatment, and after discontinuation, focusing on BNP levels and arrhythmia occurrences. Statistical analyses were performed to compare the outcomes between the two groups.
Results:
Our study cohort comprised 23 patients treated with rhIL-11 and 7 patients receiving rhTPO. The rhIL-11 group showed a significant increase in serum BNP levels from a baseline median of 418 pg/mL (IQR: 193-1205) to 3084 pg/mL (IQR: 1446-5000) within one week (P < 0.01), while the rhTPO group had no significant changes (P = NS). BNP levels in the rhIL-11 group decreased to 384.0 pg/mL (IQR: 239.0-460.0) one week post-discontinuation (P < 0.05). Cardiac arrhythmias were documented in 34.8% (8/23) of rhIL-11-treated patients, demonstrating a clear treatment duration-dependent pattern: 83.3% (5/6) of patients receiving rhIL-11 for more than two weeks developed arrhythmias, with all 3 patients (100%) treated beyond three weeks experiencing cardiac complications, including two cases of frequent ventricular tachycardia. The rhTPO group showed no significant BNP changes or arrhythmic events. Kaplan-Meier survival analysis revealed a statistically significant divergence in arrhythmia risk profiles between the two treatment groups (P < 0.05). Multivariate COX regression analysis identified age as an independent risk factor for arrhythmia development (HR 1.071, 95% CI: 1.007-1.139; p = 0.029).
Conclusions:
Prolonged rhIL-11 treatment was associated with significant elevations in BNP levels and a higher incidence of arrhythmias, particularly with longer treatment durations. These findings highlight the need for close cardiac monitoring in patients receiving extended rhIL-11 therapy. Further large-scale, prospective studies are necessary to establish clear cardiac safety guidelines for rhIL-11 use.