Tumor lysis syndrome

Background: Tumor lysis syndrome (TLS) is an oncologic emergency with limited treatment options. Although the vast majority of TLS is
associated with rapidly proliferating hematologic malignancies, it is often overlooked in solid tumor cases and has only been rarely associated
with urothelial carcinomas. The objective of this review is to investigate the clinical characteristics and outcomes of TLS in patients with urothelial
carcinoma.
Methods: Retrospective literature and case review and pooled analysis.
Results: Four cases of TLS in urothelial carcinoma were identified in over 180 published cases of TLS in solid tumors; one additional case
was included from our patient database. The median age of these patients was 72 years (range: 63-77) and 60% were female. Two patients had
urothelial carcinoma of the renal pelvis and three had bladder cancer with metastases. All of these cases were associated with therapy-induced TLS
with a median time to event of 14 days (range: 8-22 days) after receiving chemotherapy. Laboratory parameters were consistent among all cases
with elevations in uric acid and LDH, hypocalcemia, hyperphosphatemia, and hyperkalemia. Treatment for TLS included aggressive supportive
measures with intravenous hydration. One patient received hemodialysis; four of the five patients received urate oxidase, while one patient received
allopurinol as treatment support. The mortality in this case series was 60%.
Conclusion: TLS in urothelial cancer is associated with very high mortality. TLS should be considered as a differential diagnosis when evaluating
acute kidney injury and electrolyte abnormalities in patients with urothelial cancer especially in cases of high tumor volume and rapid growth.

Acute leukemia is characterized by the presence of 20% or more blasts in peripheral blood and/or bone marrow biopsy. It includes both AML & Acute ALL. However the diagnosis of AML can also be made when the blast percentage in peripheral blood or bone marrow is < 20 % if there is an associated t (8;21), inv (16), or t (16;16) chromosomal abnormality or PML-RAR fusion gene [1-3]. Tumor lysis syndrome is the most common disease related emergency in patients with leukemia & requires immediate management.

Acute pretreatment tumor lysis syndrome is a rare complication of cancer. Early recognition and aggressive management are mandatory for prevention of the adverse sequelae of the syndrome. Here we present 2 cases of pretreatment tumor lysis syndrome, concluding that this clinical entity should be in the differential diagnosis of acute renal failure associated with malignancy, as early recognition is in fact the mainstay of treatment.

Hyperleucocytosis is associated with higher morbidity and mortality related to possible development of leucostasis, tumour lysis syndrome and/or disseminated intravascular coagulation. There is insufficient evidence of the need for leukocytapheresis during early treatment of hyperleucocytosis, and its efficiency remains controversial, although leucoreduction is a measure that can prevent adverse events and death. The aim of this study was to analyse the safety and effectiveness of therapeutic leukocytapheresis and its influence on early mortality in our case series, adjusted to independent mortality risk factors described in the literature. This was a retrospective review (June 2003-June 2012) of procedures carried out for the treatment of hyperleucocytosis at the Haematology and Haemotherapy Service of Miguel Servet University Hospital. The patients&#39; data and technical information were prospectively registered for each leukocytapheresis session. Thirteen patients underwent a to...

Spontaneous regression in high-grade non-Hodgkin lymphoma is rare. Herein, the authors report the case of a 26-year-old asymptomatic HIV-infected patient presenting with bleeding per gum after a dental extraction. Initially, a complete blood count showed lymphoblasts and thrombocytopenia. Laboratory investigations were compatible with acute tumor lysis syndrome. Without any steroid or chemotherapy, both clinical and laboratory abnormalities were spontaneously returned to normal limits. However, three weeks later he developed generalized lymphadenopathy. A submandibular gland biopsy revealed to be T-cell lymphoblastic lymphoma. This was followed by the second episode of spontaneous tumor lysis syndrome and spontaneous regression of lymphadenopathy again. At this time, he was treated with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) with whole brain irradiation. During seven months of chemotherapy, the physical examination and blood chemistry were normal. Unfortu...

An 81-year-old man with Small cell lung cancer (limited type), who had been treated with various intravenous chemotherapies combined with irradiation during the previous year, was admitted to our hospital (day 1) for his third intravenous chemotherapy dose. Contrast-enhanced thoraco-abdominal computed tomography on day 1 demonstrated that the primary lung cancer had not grown (data not shown); however, multiple new metastatic tumors in the liver, up to 5 mm in diameter, were seen (Figure A). Two weeks later, the liver was markedly enlarged (Figure B) and repeated Computed tomography (CT). It demonstrated rapidly progressing; various sized multiple ring-enhanced tumors along with evidence of tumor lysis syndrome. On day 23, he died of multiple organ failure. Liver metastasis is a common occurrence in lung cancer patients, but the rapid enlargement of the liver over such a short time period is an extremely rare phenomenon. 1 REFERENCE 1. Sato K, Takeyama Y, Tanaka T, Fukui Y, Gonda H, Suzuki R. Fulminant hepatic failure and hepatomegaly caused by diffuse liver metastases from small cell lung carcinoma: 2 autopsy cases. Respir Investig. 2013; 51(2): 98-102.

Tumor lysis syndrome is characterized by multiple metabolic derangements resulting from the release of intracellular components into the bloodstream due to abrupt malignant cell death, spontaneously or following antineoplastic therapy. The syndrome is characterized by hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia, while deposition of uric acid and calcium phosphate crystals may result in acute renal failure, which is often exacerbated by concomitant intravascular volume depletion. A case of tumor lysis syndrome complicated by acute renal failure in a patient with non-Hodgkin’s lymphoma is reported and the pathophysiology, the clinical features, and the treatment options are discussed.

Tumor lysis syndrome (TLS) describes a constellation of biochemical and clinical abnormalities resulting from rapid and massive tumor cell death. TLS is frequently associated with hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia that may lead to serious clinical complications, including acute kidney injury and cardiac arrest. Identification of tumor- and patient-specific risk factors for TLS and early recognition of laboratory and clinical TLS based on established criteria are essential for preventing TLS and forestalling acute kidney injury. Early collaboration between oncologists and nephrologists will help improve assessment of patients&#39; kidney function and risk factors, paving the way for timely and efficacious interventions.

Tumor lysis syndrome is characterized by multiple metabolic derangements resulting from the release of intracellular components into the bloodstream due to abrupt malignant cell death, spontaneously or following antineoplastic therapy. The syndrome is characterized by hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia, while deposition of uric acid and calcium phosphate crystals may result in acute renal failure, which is often exacerbated by

Syndrome of inappropriate antidiuretic hormone secretion is frequent in small-cell lung carcinomas. We report on a case of syndrome of inappropriate antidiuretic hormone secretion after each of the first 2 cycles of chemotherapy for small-cell lung cancer. The association with chemotherapy-induced tumor lysis is proposed, particularly based on the course of antidiuretic hormone levels, and a review of the literature is presented. Syndrome of inappropriate antidiuretic hormone secretion can occur during tumor lysis syndrome.

The acute tumour lysis syndrome is a well recognised complication of chemotherapy for lymphoid malignancies. There are few reports, however, of this complication after corticosteroid therapy alone. We report a case of T-cell acute lymphoblastic leukaemia who developed the biochemical picture of tumour lysis after two doses of hydrocortisone given prior to platelet transfusion. Prophylactic corticosteroids prior to blood product infusion should be reserved for patients who have experienced febrile or allergic reactions in the past and it is suggested that they should only be administered to patients with active lymphoid malignancies with due caution.