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S. K. Kim, L. Espandar, J. E. Romaguera, W. F. Mieler; Bilateral Color Blindness and Retinopathy Associated With Denileukin Diftitox (Ontak) in Follicular Lymphoma Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3809. doi: https://doi.org/.
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To describe two cases of retinopathy and color blindness after treatment with denileukin diftitox (Ontak) for follicular lymphoma.
A case series and a complete literature search.
There were two patients at MD Anderson Cancer Center Ophthalmology clinic who initially presented with color vision loss during their treatment of refractory follicular lymphoma with denileukin diftitox. One patient had intact visual acuity initially with bilateral decreased color vision with RPE mottling in the macula. Fluorescein angiography (FA) showed RPE drop out with no evidence of leakage. Initial ERG was unremarkable. Patient underwent further treatment including denileukin diftitox (Ontak) and rituximab (Rituxan) for her follicular lymphoma but refused further ophthalmic evaluation and completed 6 cycles. Upon return, patient had decreased vision of 20/40 and marked RPE dropped out in the macula as well as in the periphery bilaterally. Repeat ERG was diminished for both scotopic and photopic response. FA showed diffuse RPE dropped out in the macular and in the periphery. The second patient presented similarly with symptoms of decreased color vision and central visual field depression and marked RPE dropped out in the macula. Similarly, the second patient underwent treatment under close observation, but the treatment was discontinued due to the progression of her vision loss. Her vision stabilized at 20/100 OD and 20/80 OS with clinical findings of severe RPE dropped out bilaterally in the macula as well as in the periphery. Patient’s retinal antigen auto-antibodies studies were negative. Literature search revealed two patients with solid organ tumors but these patients also had positive retinal auto-antibodies. In discussing with the pharmaceutical company (Ligand Pharmaceutical), there have been 9 such cases, but their ocular findings have not been described.
We report first two cases of color blindness and bilateral retinopathy in follicular lymphoma patients in the absence of retinal auto-antibodies associated with denileukin diftitox (Ontak). Patients with follicular lymphoma were being treated with denileukin diftitox (Ontak) should be advised of its possible adverse events.
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