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Haddad FG, Sasaki K, Senapati J, Xiao L, Park G, Abuasab T, Venugopal S, Rivera D, Bazinet A, Babakhanlou R, Kim K, Ong F, Desikan S, Pemmaraju N, Loghavi S, Borthakur G, DiNardo C, Abbas HA, Short NJ, Daver N, Jabbour E, Garcia-Manero G, Ravandi F, Kantarjian H, Kadia T. Outcomes of Patients With Newly Diagnosed AML and Hyperleukocytosis. JCO Oncol Pract 2024:OP2400027. [PMID: 39013130 DOI: 10.1200/op.24.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/03/2024] [Accepted: 06/07/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality. METHODS We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 109/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS. RESULTS The median age was 65 years (range, 23-86); the median WBC was 146 × 109/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). FLT3, NPM1, and RAS pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 109/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS. CONCLUSION Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.
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Affiliation(s)
- Fadi G Haddad
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jayastu Senapati
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace Park
- Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tareq Abuasab
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sangeetha Venugopal
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Rivera
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexandre Bazinet
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rodrick Babakhanlou
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kunhwa Kim
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Faustine Ong
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sai Desikan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hussein A Abbas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tapan Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bekele S, Kuhnly N, Chen LL. Essential Review of Oncological Emergencies. Crit Care Nurs Q 2024; 47:175-183. [PMID: 38860947 DOI: 10.1097/cnq.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Innovations in oncology have expanded treatment eligibility, leading to a rise in cancer patients requiring critical care. This necessitates that all critical care clinicians possess a fundamental knowledge of prevalent oncological conditions and identify emergent scenarios requiring immediate action. This article will explore key oncological complications and their management approaches.
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Affiliation(s)
- Sara Bekele
- Author Affiliations: Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, New York (Ms Bekele); Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Mr Kuhnly and Dr Chen)
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3
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Saillant A, Try M, Laparra A, Lecoq AL, Zaidan M. [Electrolyte disorders in oncological patients]. Bull Cancer 2024; 111:687-700. [PMID: 37208250 DOI: 10.1016/j.bulcan.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
Electrolyte disorders (ED) are common in patients with cancer and in most cases, the etiologies do not differ from the general population. They may also be induced by the cancer, its therapy or paraneoplastic syndromes. ED are associated with poor outcomes, increased morbidity and mortality in this population. Hyponatremia is the most common disorder, often multifactorial, iatrogenic or secondary to the syndrome of inappropriate antidiuretic hormone secretion, usually due to small cell lung cancer. More rarely, hyponatremia may reveal adrenal insufficiency. Hypokalemia is generally multifactorial and associated with other ED. Cisplatin and ifosfamide induce proximal tubulopathies with hypokalemia and/or hypophosphatemia. Hypomagnesemia is often iatrogenic, related to cisplatin or cetuximab, but can be prevented by supplementation. Hypercalcemia can impair life quality and be life-threatening in the most severe cases. Hypocalcemia is less common and often of iatrogenic origin. Finally, the tumor lysis syndrome is a diagnostic and therapeutic emergency that affects the prognosis of patients. Its incidence tends to increase in solid oncology, related to the improvement of therapies. Prevention and early diagnosis of ED are essential to optimize the overall management of patients with underlying cancer and cancer therapy. The aim of this review is to synthesize most frequent ED and their management.
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Affiliation(s)
- Arnaud Saillant
- Centre hospitalier universitaire de Poitiers, service d'oncologie médicale, 86021 Poitiers, France; Groupe de recherche interdisciplinaire francophone en onco-néphrologie, Paris, France.
| | - Mélanie Try
- Groupe de recherche interdisciplinaire francophone en onco-néphrologie, Paris, France; Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de néphrologie, dialyse et transplantation, 94270 Le Kremlin-Bicêtre, France
| | - Ariane Laparra
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de médecine interne-immunologie, 94270 Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service d'endocrinologie et des maladies de la reproduction, 94270 Le Kremlin-Bicêtre, France
| | - Mohamad Zaidan
- Assistance publique-Hôpitaux de Paris (AP-HP), centre hospitalier universitaire de Bicêtre, université de Paris-Saclay, service de néphrologie, dialyse et transplantation, 94270 Le Kremlin-Bicêtre, France
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4
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Henderson RD, Wilson MR. Lymphoma for the acute physician: diagnostic challenges and initial treatment decisions. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38941979 DOI: 10.12968/hmed.2024.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Prompt diagnosis of lymphoma facilitates early treatment and improves outcomes for patients. For non-haemato-oncologists, it is important to have an understanding of how lymphoma can present and the initial work-up. This review is intended to provide clinicians with background to aid clinical decisional making at presentation and when managing treatment related complications. There will be particular emphasis on emergency presentations (tumour lysis syndrome, management of patients with a mediastinal mass, infections in lymphoma patients) and novel treatment options which have unique toxicities often requiring multi-specialty expertise.
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Affiliation(s)
- Ross D Henderson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Matthew R Wilson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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5
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Wilkinson D, Yeung E, Samy S, Nakai C. Extracorporeal membrane oxygenation bridging for chemotherapy in obstructing mediastinal mass after cardiopulmonary arrest. J Cardiothorac Surg 2024; 19:382. [PMID: 38926736 PMCID: PMC11202388 DOI: 10.1186/s13019-024-02918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In a sedated patient, airway compression by a large mediastinal mass can cause acute fatal cardiopulmonary arrest. Extracorporeal membrane oxygenation (ECMO) has been investigated to protect the airway and provided cardiopulmonary stability. The use of ECMO in the management of mediastinal masses was reported, however, the management complicated by cardiopulmonary arrest is poorly documented. CASE PRESENTATION 32-year-old female presented with acute onset of left arm swelling and subacute onset of dry cough. Further investigation showed a deep venous thrombosis in left upper extremity as well as a large mediastinal mass. She underwent mediastinoscopy with biopsy of the mass which was complicated by cardiopulmonary arrest secondary to airway obstruction by the mediastinal mass. Venoarterial ECMO was initiated, while concurrently treating with a chemotherapy. The mediastinal mass responded to the chemotherapy and reduced in size during 2 days of ECMO support. She was extubated successfully and decannulated after 2 days of ECMO and discharged later. CONCLUSIONS Extracorporeal membrane oxygenation can serve as a viable strategy to facilitate cardiopulmonary support while concurrently treating the tumor with chemotherapy, ultimately allowing for the recovery of cardiopulmonary function, and achieving satisfactory outcomes.
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Affiliation(s)
- Daniel Wilkinson
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Enoch Yeung
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Sanjay Samy
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Chikashi Nakai
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA.
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6
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Li TC, Chan WC, Tsai MC, Tsai SF, Jan SL, Fu LS, Huang FL, Huang YC. Pseudohyperkalemia in pediatric patients with newly diagnosed hematological malignancies. Pediatr Hematol Oncol 2024:1-10. [PMID: 38867542 DOI: 10.1080/08880018.2024.2362157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
Patients with newly diagnosed hematological malignancies often present with a considerable cellular burden, leading to complications including hyperkalemia. However, pseudohyperkalemia, arising from in vitro cell lysis, can pose challenges in clinical practice. Although pseudohyperkalemia is frequently reported in adult hematological malignancies, its occurrence in pediatric patients is underreported, and its incidence in this demographic remains unclear. We retrospectively reviewed the medical records of pediatric patients who received a new diagnosis of hematological malignancies from 2011 to 2022 at Taichung Veterans General Hospital. Hyperkalemia was defined by a serum or plasma potassium level exceeding 5.5 mEq/L. Pseudohyperkalemia was defined by 1) a potassium decrease of over 1 mEq/L in within 4 h without intervention or 2) the absence of electrocardiography changes indicative of hyperkalemia. Cases with apparent red blood cell hemolysis were excluded. A total of 157 pediatric patients with a new diagnosis of hematological malignancies were included, 14 of whom exhibited hyperkalemia. Among these 14 cases, 7 cases (4.5%) were of pseudohyperkalemia. This rate increased to 21.2% in patients with initial hyperleukocytosis. Pseudohyperkalemia was associated with a higher initial white blood cell count and lower serum sodium level. All episodes of pseudohyperkalemia occurred in the pediatric emergency department, where samples were obtained as plasma, whereas all true hyperkalemia cases were observed in the ordinary ward or intensive care unit, where samples were obtained as serum. Timely recognition of pseudohyperkalemia is crucial to avoiding unnecessary potassium-lowering interventions in pediatric patients with newly diagnosed hematological malignancies.
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Affiliation(s)
- Ting-Chu Li
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Cheng Chan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chin Tsai
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Ling Jan
- Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lin-Shien Fu
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Fang-Liang Huang
- Division of Hematology and Oncology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- Hung Kuang University, Taichung, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Yung-Chieh Huang
- Division of Nephrology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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7
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Morschhauser F, Dahiya S, Palomba ML, Martin Garcia-Sancho A, Reguera Ortega JL, Kuruvilla J, Jäger U, Cartron G, Izutsu K, Dreyling M, Kahl B, Ghesquieres H, Ardeshna K, Goto H, Barbui AM, Abramson JS, Borchmann P, Fleury I, Mielke S, Skarbnik A, de Vos S, Kamdar M, Karmali R, Viardot A, Farazi T, Fasan O, Lymp J, Vedal M, Nishii R, Avilion A, Papuga J, Kumar J, Nastoupil LJ. Lisocabtagene maraleucel in follicular lymphoma: the phase 2 TRANSCEND FL study. Nat Med 2024:10.1038/s41591-024-02986-9. [PMID: 38830991 DOI: 10.1038/s41591-024-02986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024]
Abstract
An unmet need exists for patients with relapsed/refractory (R/R) follicular lymphoma (FL) and high-risk disease features, such as progression of disease within 24 months (POD24) from first-line immunochemotherapy or disease refractory to both CD20-targeting agent and alkylator (double refractory), due to no established standard of care and poor outcomes. Chimeric antigen receptor (CAR) T cell therapy is an option in R/R FL after two or more lines of prior systemic therapy, but there is no consensus on its optimal timing in the disease course of FL, and there are no data in second-line (2L) treatment of patients with high-risk features. Lisocabtagene maraleucel (liso-cel) is an autologous, CD19-directed, 4-1BB CAR T cell product. The phase 2 TRANSCEND FL study evaluated liso-cel in patients with R/R FL, including 2L patients who all had POD24 from diagnosis after treatment with anti-CD20 antibody and alkylator ≤6 months of FL diagnosis and/or met modified Groupe d'Etude des Lymphomes Folliculaires criteria. Primary/key secondary endpoints were independent review committee-assessed overall response rate (ORR)/complete response (CR) rate. At data cutoff, 130 patients had received liso-cel (median follow-up, 18.9 months). Primary/key secondary endpoints were met. In third-line or later FL (n = 101), ORR was 97% (95% confidence interval (CI): 91.6‒99.4), and CR rate was 94% (95% CI: 87.5‒97.8). In 2L FL (n = 23), ORR was 96% (95% CI: 78.1‒99.9); all responders achieved CR. Cytokine release syndrome occurred in 58% of patients (grade ≥3, 1%); neurological events occurred in 15% of patients (grade ≥3, 2%). Liso-cel demonstrated efficacy and safety in patients with R/R FL, including high-risk 2L FL. ClinicalTrials.gov identifier: NCT04245839 .
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Affiliation(s)
- Franck Morschhauser
- Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France.
| | - Saurabh Dahiya
- Stanford University School of Medicine, Stanford, CA, USA
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alejandro Martin Garcia-Sancho
- Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Luis Reguera Ortega
- Hospital Virgen del Rocío, Instituto de Biomedicina de la Universidad de Sevilla, Seville, Spain
| | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Guillaume Cartron
- Montpellier University Hospital Center, UMR CNRS 5535, Montpellier, France
| | - Koji Izutsu
- National Cancer Center Hospital, Tokyo, Japan
| | | | - Brad Kahl
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Kirit Ardeshna
- University College London Hospitals Biomedical Research Centre, London, UK
| | - Hideki Goto
- Hokkaido University Hospital, Sapporo, Japan
| | - Anna Maria Barbui
- Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Stephan Mielke
- Karolinska Institutet and University Hospital, Karolinska Comprehensive Cancer Center, Karolinska ATMP Center, Stockholm, Sweden
| | | | - Sven de Vos
- UCLA Santa Monica Medical Centre, Santa Monica, CA, USA
| | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Reem Karmali
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital, Ulm, Germany
| | | | | | | | - Min Vedal
- Bristol Myers Squibb, Seattle, WA, USA
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8
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Toda Y, Ashizawa M, Murahashi R, Nakashima H, Ikeda T, Kawaguchi SI, Nagayama T, Umino K, Minakata D, Morita K, Yamamoto C, Hatano K, Sato K, Fujiwara SI, Ohmine K, Kanda Y. Tumor lysis syndrome in induction therapy for acute myeloid leukemia before the rasburicase era. Int J Hematol 2024; 119:660-666. [PMID: 38575822 DOI: 10.1007/s12185-024-03752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
Guidelines recommend rasburicase for high-risk patients to prevent tumor lysis syndrome (TLS). However, little information is available on the incidence and outcome of TLS in AML patients. We analyzed 145 patients with AML who underwent induction therapy before the approval of rasburicase to evaluate the incidence of TLS and the necessity of rasburicase as prophylaxis. Three patients had already developed clinical TLS (CTLS) at diagnosis of AML, and another three developed CTLS after the initiation of chemotherapy. In patients without TLS at diagnosis of AML, the risk for developing TLS was classified as high in 44 patients, intermediate in 41 and low in 57, according to the current guidelines. Allopurinol alone was administered to prevent hyperuricemia in all patients. All three patients who developed CTLS after diagnosis of AML were at high risk of TLS, and had elevated serum creatinine levels and a WBC count greater than 200,000 per microliter at diagnosis of AML. Allopurinol may be insufficient to prevent TLS in high-risk patients with renal dysfunction at diagnosis of AML, especially those with a high tumor burden and a WBC count of 200,000 or more, which indicates that prophylactic administration of rasburicase should be considered.
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Affiliation(s)
- Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Rui Murahashi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Hirotomo Nakashima
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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9
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Zhang H, Liu J, Wu Q, Xia L. Venetoclax combined with decitabine induced tumor lysis syndrome in a young patient with acute myeloid leukemia: a case report and literature review. Anticancer Drugs 2024; 35:440-444. [PMID: 38386312 DOI: 10.1097/cad.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Venetoclax, in combination with hypomethylation agents (HMAs), is a novel treatment for leukemia patients with low chemotherapy tolerance. However, it has been reported to be a risk of causing tumor lysis syndrome (TLS) in chronic lymphocytic leukemia (CLL) and elderly acute myeloid leukemia (AML) patients. Here we report a rare case of a young adult AML patient who induced TLS after receiving a combination therapy of venetoclax with decitabine (DEC). A 36-year-old male patient presented with an unexplained fever and was diagnosed with AML-M5a. The patient was first treated with a combination of antibiotics, including voriconazole 300 mg Q12h. After the infection was relieved, he was treated with 100 mg venetoclax in combination with 75 mg/m 2 DEC. However, 12 h after the first treatment, he developed diarrhea, fatigue and other symptoms, and the laboratory results were consistent with the laboratory TLS. The patient stopped chemotherapy immediately, and TLS gradually improved after receiving rehydration, diuresis, dialysis and other treatments. Finally, the patient achieved complete remission. Based on the experience of this case and related studies, we recommend the prevention of TLS should not be limited to elderly patients taking venetoclax, and it is equally important in young patients. And reduce the dosage of venetoclax when using azole antifungal drugs.
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Affiliation(s)
- Hongyong Zhang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Lafarge A, Chean D, Whiting L, Clere-Jehl R. Management of hematological patients requiring emergency chemotherapy in the intensive care unit. Intensive Care Med 2024; 50:849-860. [PMID: 38748265 PMCID: PMC11164740 DOI: 10.1007/s00134-024-07454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
Hematological malignancies may require rapid-onset treatment because of their short doubling time, notably observed in acute leukemias and specific high-grade lymphomas. Furthermore, in targeted onco-hematological scenarios, chemotherapy is deemed necessary as an emergency measure when facing short-term, life-threatening complications associated with highly chemosensitive hematological malignancies. The risks inherent in the disease itself, or in the initiation of treatment, may then require admission to the intensive care unit (ICU) to optimize monitoring and initial management protocols. Hyperleukocytosis and leukostasis in acute leukemias, tumor lysis syndrome, and disseminated intravascular coagulation are the most frequent onco-hematological complications requiring the implementation of emergency chemotherapy in the ICU. Chemotherapy must also be started urgently in secondary hemophagocytic lymphohistiocytosis. Tumor-induced microangiopathic hemolytic anemia and plasma hyperviscosity due to malignant monoclonal gammopathy represent infrequent yet substantial indications for emergency chemotherapy. In all cases, the administration of emergency chemotherapy in the ICU requires close collaboration between intensivists and hematology specialists. In this review, we provide valuable insights that aid in the identification and treatment of patients requiring emergency chemotherapy in the ICU, offering diagnostic tools and guidance for their overall initial management.
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Affiliation(s)
- Antoine Lafarge
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France.
| | - Dara Chean
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France
| | - Livia Whiting
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital and Paris University, Paris, France
| | - Raphaël Clere-Jehl
- Médecine Intensive et Réanimation, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM (French National Institute of Health and Medical Research), UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, University of Strasbourg, Strasbourg, France
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11
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Chhabra R, Vidushi A, Rajpurohit S, Singh J, Osama MA. Spontaneous Tumor Lysis Syndrome in a Case of Hepatocellular Carcinoma with Sarcomatoid Differentiation. Indian J Surg Oncol 2024; 15:370-374. [PMID: 38741637 PMCID: PMC11088581 DOI: 10.1007/s13193-024-01895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/02/2024] [Indexed: 05/16/2024] Open
Abstract
Sarcomatoid hepatocellular carcinoma is a rare histologic variant of primary liver cancer comprising of malignant spindle cells and typical hepatocellular carcinoma (HCC). In terms of clinical presentation, they usually exhibit extensive tumor burden due to their larger size and a metastatic disease at the time of diagnosis as compared to conventional HCC. Tumor lysis syndrome is an oncological emergency, usually seen after cytotoxic chemotherapy in haematological malignancies. Here, we highlight a case of 76-year old male with no comorbidities, presenting with an excruciating backache and a paravertebral soft tissue mass and multiple osteolytic lesions, was clinically suspected to be a plasma cell neoplasm. On further evaluation, the patient was diagnosed of a sarcomatoid variant of hepatocellular carcinoma. This report showcases multiple rare findings by the presence of non-specific symptoms, non-cirrhotic liver, normal serum alpha protein levels and the occurrence of a spontaneous tumor lysis syndrome in a solid malignancy.
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Affiliation(s)
- Raja Chhabra
- Department of Medical Oncology, BLK-MAX Super Speciality Hospital, Pusa Road, New Delhi, India
| | - Aditya Vidushi
- Department of Medical Oncology, BLK-MAX Super Speciality Hospital, Pusa Road, New Delhi, India
| | - Sajjan Rajpurohit
- Department of Medical Oncology, BLK-MAX Super Speciality Hospital, Pusa Road, New Delhi, India
| | - Jasbir Singh
- Department of Pathology, BLK-MAX Super Speciality Hospital, Pusa Road, New Delhi, India
| | - Md Ali Osama
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
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12
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Schwaner I, Kuhn T, Losem C, Wolff T, Otremba B, Zaiss M, Hülsenbeck J, Famulla K, Nösslinger T, Rossi D. Low incidence of tumor lysis syndrome in elderly patients with chronic lymphocytic leukemia treated with venetoclax under real-world conditions: results from the prospective observational VeRVe study. Ann Hematol 2024; 103:2013-2020. [PMID: 38421404 PMCID: PMC11090950 DOI: 10.1007/s00277-024-05638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
Venetoclax is active in both frontline and relapsed/refractory settings for the treatment of chronic lymphocytic leukemia (CLL). Although the prevalence and severity of tumor lysis syndrome (TLS) are well characterized in clinical trials, laboratory and clinical TLS remain relatively unexplored in real-world clinical practice.In this prospective, real-world observational study, we aimed to determine the incidence and outcomes of TLS in patients with CLL receiving venetoclax outside a clinical trial. The study (VeRVe) was conducted in centers in Austria, Germany, and Switzerland.Two hundred and thirty-nine patients were treated according to local label with at least one dose of venetoclax. Patient demographics, baseline characteristics, and blood chemistry at baseline were documented, and descriptive statistical analyses were conducted.Seventy eight patients (33%) were treated with venetoclax monotherapy, 101 (42%) with venetoclax in combination with rituximab and 60 (25%) with venetoclax in combination with obinutuzumab. In all cases, the TLS risk mitigation strategy adhered to the ramp-up protocol. Median age was 73 years and 66% of patients were male. The majority of patients (75%) had relapsed/refractory CLL, 63/192 (32.8%) patients tested had a del(17p) and 93/134 (69.4%) patients tested had unmutated immunoglobulin heavy chain variable region gene (IGHV). Clinical TLS occurred in 5 patients (2.1%) and laboratory TLS occurred in 15 patients (6.3%). Ten patients received specific treatment, of which 6 were hospitalized. There were no deaths due to a TLS event and venetoclax was well-tolerated. Of the 5 clinical TLS events reported, none were fatal or resulted in renal failure (NCT03342144, registered on Nov 10, 2017).
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MESH Headings
- Humans
- Tumor Lysis Syndrome/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Aged
- Sulfonamides/therapeutic use
- Sulfonamides/adverse effects
- Sulfonamides/administration & dosage
- Male
- Female
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/adverse effects
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Aged, 80 and over
- Prospective Studies
- Incidence
- Middle Aged
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Germany/epidemiology
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Rituximab/therapeutic use
- Austria/epidemiology
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
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Affiliation(s)
- Ingo Schwaner
- Onkologische Schwerpunktpraxis Kurfuerstendamm, Kurfuerstendamm 65, 10707, Berlin, Germany.
| | - Thomas Kuhn
- AbbVie Deutschland GmbH & Co. KG, Hämatologie, Wiesbaden, Germany
| | | | | | | | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Kirsten Famulla
- AbbVie Deutschland GmbH & Co. KG, Hämatologie, Wiesbaden, Germany
| | - Thomas Nösslinger
- 3rd Medical Department for Hematology and Oncology, Hanusch Krankenhaus, Wien, Austria
| | - Davide Rossi
- Clinic of Hematology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
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13
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Sudalaimuthu M, Juthani R, Babu V, Kar R, Basu D. Peripheral blood smear and bone marrow findings in spontaneous tumour lysis syndrome associated with haematolymphoid malignancies. J Clin Pathol 2024:jcp-2024-209456. [PMID: 38769002 DOI: 10.1136/jcp-2024-209456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Muthu Sudalaimuthu
- Dept. of Pathology, SRM Medical College and Research Center, Kattankulathur, Tamil Nadu, India
| | - Ronit Juthani
- Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Vishva Babu
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rakhee Kar
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debdatta Basu
- Pathology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, Puducherry, India
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14
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Abufara AA, Alsahouri MI, Alsalah QA, Arafat H, Hammouri AG, Aqeel BA. Spontaneous tumor lysis syndrome in an adult with alveolar rhabdomyosarcoma: a challenging diagnosis. Oxf Med Case Reports 2024; 2024:omae043. [PMID: 38784777 PMCID: PMC11110853 DOI: 10.1093/omcr/omae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
Tumor lysis syndrome (TLS) is an oncological emergency characterized by metabolic and electrolyte imbalances associated with the rapid destruction of tumor cells. It is commonly recognized when cytotoxic treatment for hematological malignancies is initiated. Spontaneous TLS with solid tumors like rhabdomyosarcoma (RMS) is exceedingly rare. It has been noted that the highest incidence of this tumor occurs in individuals under the age of 20 years, with an incidence rate of 4.4 cases per 1 million. Here, we present the case of a 22-year-old male who presented with spontaneous clinical TLS. A computed tomography (CT) scan revealed a large pelvic mass, diffuse lymphadenopathy, and infiltration of the ocular muscles. Subsequently, a biopsy was conducted, and the histopathological results indicated alveolar rhabdomyosarcoma. Our literature review revealed five cases of spontaneous TLS caused by RMS, with our patient being the only adult among all published cases.
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Affiliation(s)
- Arein A Abufara
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
| | | | - Qusai A Alsalah
- Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine
| | - Hasan Arafat
- Department of Internal Medicine, Augusta Victoria Hospital, Jerusalem, Palestine
| | | | - Bashir Abu Aqeel
- Cancer Care Center, Augusta Victoria Hospital, Jerusalem, Palestine
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15
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Kikuchi M, Miyabe R, Matsushima H, Kita H, Kobayashi J, Ando T, Atsuta K, Shintani T. Tumor lysis syndrome following letrozole for locally advanced breast cancer: a case report. Surg Case Rep 2024; 10:100. [PMID: 38656713 PMCID: PMC11043241 DOI: 10.1186/s40792-024-01901-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Letrozole, an aromatase inhibitor, is used to treat breast cancer in postmenopausal women. Tumor lysis syndrome (TLS) is a complication that can trigger multiple organ failure caused by the release of intracellular nucleic acids, phosphate, and potassium into the blood due to rapid tumor cell disintegration induced by drug therapy. TLS is uncommon in solid tumors and occurs primarily in patients receiving chemotherapy. Herein, we report a rare occurrence of TLS that developed in a patient with locally advanced breast cancer following treatment with letrozole. CASE PRESENTATION An 80-year-old woman with increased bleeding from a fist-sized left-sided breast mass presented to our hospital. Histological examination led to a diagnosis of invasive ductal carcinoma of the luminal type. The patient refused chemotherapy and was administered hormonal therapy with letrozole. Seven days after letrozole initiation, she complained of anorexia and diarrhea. Blood test results revealed elevated blood urea nitrogen (BUN) and creatinine (Cr) levels, and she was admitted to our hospital for intravenous infusions. On the second day after admission, marked elevations of LDH, BUN, Cr, potassium, calcium, and uric acid levels were observed. Furthermore, metabolic acidosis and prolonged coagulation capacity were observed. We suspected TLS and discontinued letrozole, and the patient was treated with hydration, febuxostat, and maintenance hemodialysis. On the third day after admission, her respiratory status worsened because of acute respiratory distress syndrome associated with hypercytokinemia, and she was intubated. On the fourth day after admission, her general condition did not improve, and she died. CONCLUSIONS Although TLS typically occurs after chemotherapy initiation, the findings from the present case confirm that this syndrome can also occur after hormonal therapy initiation and should be treated with caution.
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Affiliation(s)
- Masayuki Kikuchi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan.
| | - Rika Miyabe
- Tosen Clinic, 1-20, Gohuku-cho, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0031, Japan
| | - Hirokazu Matsushima
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Hidenori Kita
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Junko Kobayashi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Takashi Ando
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Koji Atsuta
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
| | - Tsunehiro Shintani
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Otemachi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-0853, Japan
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16
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Choi Y, Kim BK, Won JH, Yoo JW, Choi W, Jung S, Kim JY, Choi IY, Chung NG, Lee JW, Choi JY, Kang HJ, Lee H. A Study to Evaluate the Effectiveness and Safety of Prephase Steroid Treatment before Remission Induction Chemotherapy in Patients with Pediatric Acute Lymphoblastic Leukemia Using Common Data Model-Based Real-World Data: A Retrospective Observational Study. Clin Epidemiol 2024; 16:293-304. [PMID: 38681782 PMCID: PMC11049150 DOI: 10.2147/clep.s454263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
Background Rapid reduction of leukemic cells in the bone marrow during remission induction chemotherapy (RIC) can lead to significant complications such as tumor lysis syndrome (TLS). We investigated whether prephase steroid treatment before RIC could decrease TLS incidence and improve overall survival in pediatric patients with acute lymphoblastic leukemia (ALL). Methods Data were extracted from the Common Data Model databases in two tertiary-care hospitals in Seoul, South Korea. Patients were classified into the treated or untreated group if they had received RIC with prephase steroid treatment ≥7 days before RIC in 2012-2021 or not, respectively. Stabilized Inverse Probability of Treatment Weighting (sIPTW) was applied to ensure compatibility between the treated and untreated groups. The incidence of TLS within 14 days of starting RIC, overall survival (OS), and the incidence of adverse events of special interest were the primary endpoints. Multiple sensitivity analyses were performed. Results Baseline characteristics were effectively balanced between the treated (n=308.4) and untreated (n=246.6) groups after sIPTW. Prephase steroid treatment was associated with a significant 88% reduction in the risk of TLS (OR 0.12, 95% CI: 0.03-0.41). OS was numerically greater in the treated group than in the untreated group although the difference was not statistically significant (HR 0.64, 95% CI 0.25-1.64). The treated group experienced significantly elevated risks for hyperbilirubinemia and hyperglycemia. The reduction in TLS risk by prephase steroid treatment was maintained in all of the sensitivity analyses. Conclusion Prephase steroid treatment for ≥7 days before RIC in pediatric patients with ALL reduces the risk of TLS, while careful monitoring for toxicities is necessary. If adequately analyzed, real-world data can provide crucial effectiveness and safety information for proper management of pediatric patients with ALL, for whom prospective randomized studies may be difficult to perform for ethical and practical reasons.
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Affiliation(s)
- Yoona Choi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Center for Convergence Approaches in Drug Development, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Bo Kyung Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Jung-Hyun Won
- Center for Convergence Approaches in Drug Development, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Jae Won Yoo
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Wona Choi
- Department of Medical Informatics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Surin Jung
- Department of Medical Informatics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Yoon Kim
- Department of Medical Informatics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
- Department of Biomedicine & Health Sciences, the Catholic University of Korea, Seoul, Republic of Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Howard Lee
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Center for Convergence Approaches in Drug Development, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
- Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
- Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul, Republic of Korea
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17
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Pourhassan H, Kareem W, Agrawal V, Aldoss I. Important Considerations in the Intensive Care Management of Acute Leukemias. J Intensive Care Med 2024; 39:291-305. [PMID: 37990559 DOI: 10.1177/08850666231193955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
In the realm of hematologic disorders, acute leukemia is approached as an emergent disease given the multitude of complications and challenges that present both as a result of inherent disease pathology and adverse events associated with antineoplastic therapies and interventions. The heavy burden of leukemic cells may lead to complications including tumor lysis syndrome, hyperleukocytosis, leukostasis, and differentiation syndrome, and the initiation of treatment can further exacerbate these effects. Capillary leak syndrome is observed as a result of antineoplastic agents used in acute leukemia, and L-asparaginase, a bacterial-derived enzyme, has a unique side effect profile including association with thrombosis. Thrombohemorrhagic syndrome and malignancy-associated thrombosis are also commonly observed complications due to direct disequilibrium in coagulant and anticoagulant factors. Due to inherent effects on the white blood cell milieu, leukemia patients are inherently immunocompromised and vulnerable to life-threatening sepsis. Lastly, the advents of newer therapies such as chimeric antigen receptor (CAR) T-cells have clinicians facing the management of related toxicities on unfamiliar territory. This review aims to discuss these acute leukemia-associated complications, their pathology, and management recommendations.
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Affiliation(s)
- Hoda Pourhassan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Waasil Kareem
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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18
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Lu SY, Hsu HY, Hsieh YW, Lu CR, Huang HY, Chang SS. Prescribing cascades of antigout medications from thiazide diuretics in gout-naïve hypertensive adults receiving first-line pharmacological management. Sci Rep 2024; 14:7402. [PMID: 38548957 PMCID: PMC10978838 DOI: 10.1038/s41598-024-58153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
Prescribing cascade is a significant clinical problem but is often overlooked. We explore the incidence of the prescribing cascades of antigout medications related to thiazide treatment in gout-naïve hypertensive adults newly exposed to the pharmacological treatment. This population-based, retrospective cohort study used the Taiwan National Health Insurance Registry Database. Gout-naïve hypertensive adults who were newly dispensed first-line antihypertensive drugs between January 1, 2000, and December 31, 2016, were enrolled. Patients were divided into the thiazide group (n = 4192) and the non-thiazide group (n = 81,083). The non-thiazide group included patients who received an angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-blocker. The study utilized propensity score matching and multivariable Cox regression models to investigate the prescribing cascade of antigout agents following antihypertensive treatment, adjusting for factors like age, sex, comorbidities, and concurrent medications. After propensity score matching, each group consisted of 4045 patients, with the thiazide group exhibiting a higher risk of being prescribed antigout medications across different time intervals post-treatment initiation. Specifically, adjusted hazard ratios (aHRs) for the thiazide group were 2.23, 2.07, and 2.41 for < 30 days, 31-180 days, and > 180 days, respectively, indicating a sustained and significant risk over time. Comparative analyses revealed thiazide diuretics were associated with a higher risk of antigout medication prescriptions compared to other antihypertensive classes, particularly evident after 180 days. Subgroup analyses across various demographics and comorbidities consistently showed an increased risk in the thiazide cohort. Gout-naïve hypertensive adults newly dispensed thiazide had a higher risk of subsequently adding antigout agents than those taking other first-line antihypertensive medications. The awareness and interruption of these prescribing cascades are critical to improving patient safety.
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Affiliation(s)
- Shang-Yeh Lu
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Xueshi Rd., Taichung, Taiwan
| | - Hsing-Yu Hsu
- Department of Pharmacy, China Medical University Hospital, No. 2, Yuder Rd., Taichung, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Taipei, Taiwan
| | - Yow-Wen Hsieh
- Department of Pharmacy, China Medical University Hospital, No. 2, Yuder Rd., Taichung, Taiwan
- School of Pharmacy, College of Pharmacy, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung, Taiwan
| | - Chiung-Ray Lu
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan
| | - Hsin-Yi Huang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan.
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung City, Taiwan.
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19
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Pan S, Shen Q, Zhou J, Li T. Spontaneous tumor lysis syndrome (STLS) during biopsy for burkitt lymphoma: a case report. BMC Pediatr 2024; 24:209. [PMID: 38521927 PMCID: PMC10960423 DOI: 10.1186/s12887-024-04679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Tumor lysis syndrome (TLS) is a hematologic oncological emergency characterized by metabolic and electrolyte imbalances. On breakdown of tumor cells, enormous amounts of potassium, phosphate, and nucleic acids are released into systemic circulation. TLS mainly occurs during chemotherapy. However, there are rare incidences of spontaneous tumor lysis syndrome (STLS) prior to commencement of therapy. CASE PRESENTATION In the case being reported, the child had just undergone a biopsy. As the incision was being closed, there was a sudden onset of high fever, arrhythmia, severe hyperkalemia, hypocalcemia, and acidosis. Following timely symptomatic treatment and continuous renal replacement therapy(CRRT), the child's laboratory results improved, and organ function was restored to normal. The final pathological diagnosis confirmed Burkitt lymphoma. The boy is currently on maintenance chemotherapy. CONCLUSIONS TLS is a potentially life-threatening complication in hematologic oncology. Several important conclusions can be drawn from this case, reminding clinicians to: (1) be fully aware of the risk factors of TLS and evaluate the level of risk; (2) pay attention to the possibility of STLS during operation, if surgical procedures are necessary and operate with minimal trauma and in the shortest time possibly; (3) take preoperative prophylaxis actively for high-risk TLS patients, including aggressive fluid management and rational use of diuretics and uric-acid-lowering drugs. In addition, this case confirms the effectiveness of CRRT for severe STLS.
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Affiliation(s)
- Sirui Pan
- Department of Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qiyang Shen
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jianfeng Zhou
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Li
- Department of Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China.
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20
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Xiao Y, Xiao L, Zhang Y, Xu X, Guan X, Guo Y, Shen Y, Lei X, Dou Y, Yu J. Prediction of tumor lysis syndrome in childhood acute lymphoblastic leukemia based on machine learning models: a retrospective study. Front Oncol 2024; 14:1337295. [PMID: 38515564 PMCID: PMC10955075 DOI: 10.3389/fonc.2024.1337295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background Tumor lysis syndrome (TLS) often occurs early after induction chemotherapy for acute lymphoblastic leukemia (ALL) and can rapidly progress. This study aimed to construct a machine learning model to predict the risk of TLS using clinical indicators at the time of ALL diagnosis. Methods This observational cohort study was conducted at the National Clinical Research Center for Child Health and Disease. Data were collected from pediatric ALL patients diagnosed between December 2008 and December 2021. Four machine learning models were constructed using the Least Absolute Shrinkage and Selection Operator (LASSO) to select key clinical indicators for model construction. Results The study included 2,243 pediatric ALL patients, and the occurrence of TLS was 8.87%. A total of 33 indicators with missing values ≤30% were collected, and 12 risk factors were selected through LASSO regression analysis. The CatBoost model with the best performance after feature screening was selected to predict the TLS of ALL patients. The CatBoost model had an AUC of 0.832 and an accuracy of 0.758. The risk factors most associated with TLS were the absence of potassium, phosphorus, aspartate transaminase (AST), white blood cell count (WBC), and urea levels. Conclusion We developed the first TLS prediction model for pediatric ALL to assist clinicians in risk stratification at diagnosis and in developing personalized treatment protocols. This study is registered on the China Clinical Trials Registry platform (ChiCTR2200060616). Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2200060616.
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Affiliation(s)
- Yao Xiao
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Li Xiao
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yang Zhang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Ximing Xu
- Big Data Engineering Center for Children’s Medical Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xianmin Guan
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yuxia Guo
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yali Shen
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - XiaoYing Lei
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ying Dou
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jie Yu
- Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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21
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Attieh RM, Begum F, Chitty D, Izzedine H, Jhaveri KD. Kidney and Urinary Tract Involvement in Chronic Myelomonocytic Leukemia. Kidney Med 2024; 6:100769. [PMID: 38313809 PMCID: PMC10837097 DOI: 10.1016/j.xkme.2023.100769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy affecting the bone marrow and resulting in peripheral blood monocytosis. Kidney and urinary tract involvement is common and can present dramatically with life-threatening consequences. Kidney involvement can be the result of direct or indirect mechanisms, including prerenal azotemia, glomerular disease, tubulointerstitial involvement, and renovascular disorders. Urinary tract involvement, electrolyte and acid-base disorders, as well as nephrotoxicity from treatment of the disorder can also occur. Given this multifactorial pathogenesis involving several mechanisms concomitantly, nephrologists must exercise heightened awareness and maintain a low threshold for kidney biopsy. There is a pressing need for future research endeavors to elucidate and target the manifestations of CMML that involve the kidneys with the ultimate goal of augmenting overall prognosis and therapeutic outcomes.
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Affiliation(s)
- Rose Mary Attieh
- Division of Kidney Diseases and Hypertension, Department of Medicine, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Farhana Begum
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - David Chitty
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institute for Medical Research, Lake Success, New York
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
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22
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Dreher N, Dörrler AL, Kraus S, Higuchi T, Serfling SE, Samnick S, Einsele H, Grigoleit GU, Buck AK, Werner RA. C-X-C Motif Chemokine Receptor 4-Targeted Radioligand Therapy in Hematological Malignancies-Myeloablative Effects, Antilymphoma Activity, and Safety Profile. Clin Nucl Med 2024; 49:146-151. [PMID: 38081189 DOI: 10.1097/rlu.0000000000004974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND After C-X-C motif chemokine receptor 4 (CXCR4)-directed radioligand therapy (RLT), lymphoma patients are scheduled for conditioning therapy (CON) followed by hematopoietic stem cell transplantation (HSCT). We aimed to determine whether CXCR4-RLT can achieve bone marrow ablation and direct antilymphoma activity independent from CON/HSCT and also evaluated the safety profile of this theranostic approach in an acute setting. PATIENTS AND METHODS After CXCR4-directed 68 Ga-pentixafor PET/CT, 21 heavily pretreated patients with hematological malignancies underwent CXCR4-directed RLT using 90 Y-pentixather. The extent of myeloablative efficacy was determined by investigating hematologic laboratory parameters before RLT (day -1), at the day of RLT (day 0), 2 days after RLT (day 2), and before CON (median day 10). Serving as surrogate marker of antilymphoma activity, lactate dehydrogenase (LDH) levels were also assessed until CON. We also screened for laboratory-defined tumor lysis syndrome after the Cairo-Bishop definition and recorded acute laboratory adverse events using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS After RLT, we observed a significant decline of leukocyte levels by 79.4% ± 18.7% till CON (granulocytes, drop by 70.3% ± 21%; platelets, reduction by 43.1% ± 36%; P ≤ 0.0005 vs day 0, respectively). After RLT, LDH levels already reached a peak at day 2, which was followed by a rapid decline thereafter (peak vs day of CON, P = 0.0006), indicating that 90 Y-pentixather exhibits direct antilymphoma activity. At day of CON, LDH levels were also significantly lower when compared with day -1 ( P = 0.04), suggestive for durable response mediated by RLT. No patient fulfilled the criteria of tumor lysis syndrome, whereas 25 laboratory adverse events attributable to CXCR4-directed treatment were identified (≥grade 3 in 2/25 [8%]). During further treatment course, all patients (100%) received HSCT. CONCLUSIONS CXCR4-directed RLT causes effective myeloablation, which allows for HSCT. In addition, it also exerts direct antilymphoma activity independent of subsequent therapeutic steps, whereas safety profile was acceptable.
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Affiliation(s)
| | | | - Sabrina Kraus
- Division of Hematology and Oncology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg
| | | | | | | | - Hermann Einsele
- Division of Hematology and Oncology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg
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23
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Bozkurt S, Genc DB, Vural S. Laboratory and clinical features of tumor lysis syndrome in children with non-Hodgkin lymphoma and evaluation of long-term renal functions in survivors. BMC Pediatr 2024; 24:85. [PMID: 38297237 PMCID: PMC10829167 DOI: 10.1186/s12887-024-04549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE The purpose of our study is to investigate the laboratory and clinical features of tumor lysis syndrome (TLS) and acute kidney injury (AKI) in childhood non-Hodgkin lymphomas (NHL) and to reveal their impact on long term kidney function in survivors. METHODS Our single-center retrospective study included 107 patients (0-18 years old) with NHL who were admitted and treated at our hospital between 1998 and 2020. The relationship between TLS and age, gender, histopathological subgroup, tumor stage, lactate dehydrogenase (LDH) level at presentation, bone marrow and kidney involvement were assessed. The long-term renal functions of the patients were investigated. RESULTS 80.3% of the patients were male with a median age of 9.8 years. The most common detected histopathological subgroup was Burkitt lymphoma. Hyperhydration with or without alkalinisation, and allopurinol were used in first-line treatment and prophylaxis of TLS. Laboratory TLS and clinical TLS was observed in 30.8% and 12.1% of patients, respectively. A significant correlation was found between young age, advanced stage, high LDH level at presentation, and TLS. AKI was observed in 12.1% of the patients. When the glomerular filtration rate values of the patients at the first and last admissions were compared after an average of 6.9 years, a mean decrease of 10 mL/min/1.73 m2 was found. It was not, however, found to be statistically significant. CONCLUSION Lower age, advanced stage, and high LDH level at presentation were found to be risk factors for TLS in our study. Long-term renal function loss was not observed in the survivors who received early and careful prophylaxis/treatment for TLS. The survivors are still being followed up.
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Affiliation(s)
- Selcen Bozkurt
- Department of Pediatric Allergy-Immunology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Dildar Bahar Genc
- Department of Pediatric Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sema Vural
- Department of Pediatric Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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24
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Prasad A, Verghese D, Vijaya Rangan S, Sunadarajan N. Spontaneous tumour lysis secondary to gastric adenocarcinoma. BMJ Case Rep 2024; 17:e258369. [PMID: 38191220 PMCID: PMC10806900 DOI: 10.1136/bcr-2023-258369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
We present a case of a man in his 70s who presented with worsening rectal and back pain associated with weight loss, dyspnoea and brownish discolouration of urine. Physical examination noted abdominal distention and epigastric tenderness. Laboratory investigations revealed acute kidney injury, hyperkalaemia, hyperphosphataemia and hyperuricaemia. Contrast CT of the abdomen/pelvis showed multiple, low-density masses throughout the liver, suspicious for metastatic disease. Oesophagogastroduodenoscopy demonstrated a large, fungating, infiltrative and ulcerated mass in the gastric body and lesser curvature of the stomach. Surgical pathology confirmed invasive moderately differentiated gastric adenocarcinoma. He met both the laboratory and clinical criteria for spontaneous tumour lysis syndrome (STLS) as per the Cairo-Bishop criteria. He was managed with aggressive fluid hydration, rasburicase and allopurinol, resulting in improvement in his renal function and laboratory findings. STLS of solid organ tumours, especially gastric adenocarcinoma, is rare and requires early detection with timely management to ensure favourable outcomes.
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Affiliation(s)
- Apurwa Prasad
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dhiran Verghese
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
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25
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Herrero-Goñi M, Zugazabeitia Irazábal A, Madariaga L, Chávarri Gil E, Gondra L, Aguirre Meñica M. Use of rasburicase to improve kidney function in children with hyperuricemia and acute kidney injury. Clin Exp Nephrol 2024; 28:13-22. [PMID: 37751013 PMCID: PMC10766662 DOI: 10.1007/s10157-023-02394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/10/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Hyperuricemia contributes to decrease in kidney function and induces additional renal damage in children with acute kidney injury (AKI). Rasburicase oxidizes uric acid (UA), decreasing its serum quantities in less than 24 h. METHODS This is a retrospective study involving hospitalized patients under 18 years of age with underlying pathology diagnosed with AKI and severe hyperuricemia treated with rasburicase over a 4-year period. RESULTS We describe 15 patients from 4 days of life to 18 years (median: 4.4 years). Seventy-three percent had known underlying pathologies. All presented worsening of basal renal function or AKI data. All received the usual medical treatment for AKI without response. Twenty percent received an extrarenal depuration technique. All had hyperuricemia with a mean (± SD) of 13.1 (± 2.19) mg/dl. After rasburicase administration UA levels fell to a mean (± SD) of 0.76 (± 0.62) mg/dl (p < 0.001) in less than 24 h. In parallel, a decrease in the mean plasma creatinine was observed (2.92 mg/dl to 1.93 mg/dl (p = 0.057)) together with a significant improvement of the mean glomerular filtration rate (16.3 ml/min/1.73 m2 to 78.6 ml/min/1.73 m2) (p = 0.001)). No side effects were recorded. Kidney function normalized in all cases or returned to baseline levels. CONCLUSIONS Although the use of rasburicase is not routinely approved in pediatric patients with severe hyperuricemia and AKI, it has been used successfully without complications, and helped prevent progressive kidney damage. This study could serve as a basis for suggesting the off-label use of rasburicase for the management of complex pediatric patients in whom UA plays an important role in the development of AKI.
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Affiliation(s)
- María Herrero-Goñi
- Department of Pediatric Nephrology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain.
| | - Amaia Zugazabeitia Irazábal
- Department of Pediatrics, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Leire Madariaga
- Department of Pediatric Nephrology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, CIBERDEM, CIBERER, University of the Basque Country (UPV-EHU), Barakaldo, Bizkaia, Spain
| | | | - Leire Gondra
- Department of Pediatric Nephrology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, CIBERDEM, CIBERER, University of the Basque Country (UPV-EHU), Barakaldo, Bizkaia, Spain
| | - Mireia Aguirre Meñica
- Department of Pediatric Nephrology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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26
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Hu Z, Muller B, Slone JS, Inaba H. Cough, Neck Pain, and Right Facial Paralysis in a 14-year-old with Autism. Pediatr Rev 2024; 45:47-51. [PMID: 38161159 DOI: 10.1542/pir.2022-005512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Zhongbo Hu
- Hospitalist Medicine Program, Department of Oncology
| | | | - Jeremy S Slone
- Hospitalist Medicine Program, Department of Oncology
- Global Pediatric Medicine
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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27
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Sano H, Kobayashi R, Suzuki D, Yanagi M, Hori D, Matsushima S, Kobayashi K. Analysis of non-alcoholic fatty liver disease during induction therapy for B-cell precursor acute lymphoblastic leukemia in children and adolescents. Pediatr Neonatol 2024; 65:23-30. [PMID: 37482442 DOI: 10.1016/j.pedneo.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A prospective evaluation of non-alcoholic fatty liver disease (NAFLD) during induction therapy for acute lymphoblastic leukemia (ALL) has not been performed. Herein, we prospectively investigated the frequency, risk factors, and outcomes of NAFLD during induction therapy in children and adolescents with B-cell precursor ALL (BCP-ALL). METHODS This study enrolled 74 newly diagnosed BCP-ALL cases aged 1 year and older who were admitted to our department between January 2011 and December 2020. Median age was 6.6 years (1.3-17.5 years). Plain computed tomography (CT) of the upper abdomen was performed before induction therapy, and on days 15 and 29 after initiation of induction therapy. Patients with a liver/spleen CT ratio <0.9 were defined as having NAFLD. RESULTS The frequency of NAFLD was 73%. Patients with NAFLD had a higher rate of hypertriglyceridemia. There was no significant difference in 5-year overall survival and event-free survival (EFS) between patients with and without NAFLD. However, after restricting the target age to 10 years and older, 5-year EFS was significantly higher in patients with NAFLD than in those without (88.5 vs. 42.9%, respectively, P = 0.037). Similarly, 5-year cumulative incidence of relapse (CIR) was significantly lower in patients with NAFLD than in those without it (5-year CIR, 6.3 vs. 57.1%, respectively, P = 0.013). CONCLUSION Patients with NAFLD exhibit better outcomes including 5-year EFS and CIR. Further studies are necessary.
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Affiliation(s)
- Hirozumi Sano
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan.
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
| | - Daisuke Suzuki
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
| | - Masato Yanagi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
| | - Daiki Hori
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
| | - Satoru Matsushima
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
| | - Kunihiko Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Japan
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28
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Mohammad Khuzaini A, Mohd Baharudin JA, Md Fauzi A, Zulkeflee HA, Abdul Halim H, Mazli SK, Osman NFB. Tumour lysis syndrome in a neonate with transient abnormal myelopoiesis. J Neonatal Perinatal Med 2024; 17:269-273. [PMID: 38728206 DOI: 10.3233/npm-230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Tumor lysis syndrome (TLS) is an oncological emergency associated with hematological malignancies or highly proliferative solid tumors, commonly after chemotherapy. It is rarely associated with transient abnormal myelopoiesis. OBSERVATION We report a rare case of a neonate with transient abnormal myelopoiesis and tumor lysis syndrome, complicated with concomitant heart failure due to an underlying atrioventricular septal defect. Hyperhydration was contraindicated due to heart failure. The patient was managed conservatively with full recovery. CONCLUSION Tumor lysis syndrome should be suspected in neonates with transient abnormal myelopoiesis with electrolyte abnormalities. Treatment options should be considered carefully for their risks and benefits.
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Affiliation(s)
- A Mohammad Khuzaini
- Paediatric Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Paediatric Department, Hospital Ampang, Ampang, Malaysia
| | - J A Mohd Baharudin
- Paediatric Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Paediatric Department, Hospital Ampang, Ampang, Malaysia
| | - A Md Fauzi
- Department of Medical Science, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Haematology Department, Hospital Ampang, Ampang, Malaysia
| | - H A Zulkeflee
- Department of Medical Science, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Haematology Department, Hospital Ampang, Ampang, Malaysia
| | - H Abdul Halim
- Paediatric Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Paediatric Department, Hospital Ampang, Ampang, Malaysia
| | - S K Mazli
- Paediatric Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam, Nilai, Malaysia
- Paediatric Department, Hospital Ampang, Ampang, Malaysia
| | - N F B Osman
- Paediatric Department, Hospital Ampang, Ampang, Malaysia
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29
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Garkusha TA, Stolyarevich ES, Khorzhevskii VA, Ivliev SV, Firsov MA. [Pathology of the kidneys in malignant tumors of various localizations and antitumor therapy]. Arkh Patol 2024; 86:59-66. [PMID: 38881007 DOI: 10.17116/patol20248603159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Non-tumorlesions of the kidneys in malignant neoplasms are very diverse. They can alter the results of chemotherapy and lead to death in the long term. In this regard, the related discipline of onconephrology has increasingly begun to be identified, which emphasizes the importance of diagnosing non-tumor kidney lesions in this category of patients. This review is devoted to the classification, diagnosis, course, prevention and treatment of non-tumor kidney lesions in patients with malignant neoplasms. There are four groups of lesions: mechanical damage; nephropathy due to anticancer therapy; paraneoplastic nephropathy; lesions associated with metabolic disorders. Kidney lesions in patients with malignant neoplasms are characterized by a variable course. In some cases, acute renal failure develops. Others are characterized by an asymptomatic course with an outcome in nephrosclerosis. Timely diagnosis and treatment of kidney lesions in malignant neoplasms can improve the quality of life and prognosis of patients with malignant neoplasms.
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Affiliation(s)
- T A Garkusha
- Krasnoyarsk Regional Pathoanatomical Bureau, Krasnoyarsk, Russia
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - E S Stolyarevich
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- City Clinical Hospital No. 52, Moscow, Russia
| | - V A Khorzhevskii
- Krasnoyarsk Regional Pathoanatomical Bureau, Krasnoyarsk, Russia
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S V Ivliev
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
| | - M A Firsov
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
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30
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Hong G. Afatinib-Induced Tumor Lysis Syndrome in Pulmonary Adenocarcinoma: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2144. [PMID: 38138247 PMCID: PMC10745128 DOI: 10.3390/medicina59122144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Tumor lysis syndrome (TLS) is a potentially fatal oncological emergency that typically develops during the treatment of rapidly proliferating malignancies. It is infrequently reported in solid tumors, such as pulmonary adenocarcinoma. A 59-year-old male patient with shortness of breath presented with a 3.3 cm × 3.0 cm mass in the right upper lobe, along with massive right-sided pleural effusion. A percutaneous needle biopsy was performed, and a diagnosis of pulmonary adenocarcinoma with an epidermal growth factor receptor (EGFR) mutation was made. The patient was treated with afatinib because of the malignant pleural effusion and multiple metastases to the intrathoracic lymph nodes, left scapula, and brain. After 4 days of afatinib treatment, he developed oliguric acute kidney injury and progressively worsening dyspnea. Based on the clinical and laboratory findings, the patient was diagnosed with afatinib-induced TLS. To the best of our knowledge, this is the first reported case of afatinib-induced TLS in pulmonary adenocarcinoma.
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Affiliation(s)
- Goohyeon Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Republic of Korea
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31
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Lee H, Han JH, Kim JK, Yoo J, Cho HS, Yoon JH, Cho BS, Kim HJ, Lim J, Jekarl DW, Kim Y. Effectiveness of leukapheresis on early survival in acute myeloid leukemia: An observational propensity score matching cohort study. J Clin Apher 2023; 38:727-737. [PMID: 37786990 DOI: 10.1002/jca.22090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The association between leukapheresis (LK) as a treatment option for hyperleukocytosis (HL) in patients with acute myeloid leukemia (AML) remains controversial. METHODS Data were extracted from the electronic medical record for 2801 patients with AML between April 2009 and December 2019. LK was performed when the leukocyte count was ≥100 × 109 /L at the time initial bone marrow examination. RESULTS A comparison between the patients with HL in the non-LK (n = 1579) and LK (n = 208) groups revealed survival probabilities (%) of 93.2% and 90.4% (P = .130) for day 30 (D30), 85.4% and 84.2% (P = .196) for D60, and 83.6% and 80.8% (P = .258) for D90, respectively. After propensity score matching, a comparison between the patients with HL in the non-LK (n = 192) and LK (n = 192) groups revealed survival probabilities (%) of 83.9% and 91.2% (P = .030) for D30, 75.0% and 84.9% (P = .015) for day 60 (D60), and 62.4% and 81.3% (P = .034) for day 90 (D90), respectively. After D150, the observed effect of LK appeared to be mitigated without a survival benefit. DISCUSSION LK was associated with improved early survival outcomes at D30, D60, and D90 among patients with AML exhibiting HL. Thus, it may be considered a treatment option for reducing cell mass in such patients.
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Affiliation(s)
- Howon Lee
- Department of Laboratory Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jay Ho Han
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kwon Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeeun Yoo
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Suk Cho
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Laboratory Medicine, Apheresis Unit, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Sik Cho
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Wook Jekarl
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Laboratory Medicine, Apheresis Unit, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Research and Development Institute for In Vitro Diagnostic Medical Devices, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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32
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Joseph A, Zafrani L. How I Treat Tumor Lysis Syndrome. Clin J Am Soc Nephrol 2023; 18:1634-1636. [PMID: 37788006 PMCID: PMC10723907 DOI: 10.2215/cjn.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Adrien Joseph
- Department of medical intensive care unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Lara Zafrani
- Department of medical intensive care unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Paris, France
- INSERM U944, Saint-Louis Research Institute, University of Paris Cité, Paris, France
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Massaro F, Andreozzi F, Vandevoorde C, Bron D. Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life. Cancers (Basel) 2023; 15:5381. [PMID: 38001641 PMCID: PMC10670135 DOI: 10.3390/cancers15225381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The patient should be involved in the discussion, sufficiently informed and able to express himself and his expectations in terms of quality of life. However, this informed consent is conditioned by the ability of the patient to understand the risks and benefits of the treatment. Decline in quality of life is an important parameter for older patients with cancer and many prospective trials have now confirmed the impact of different side effects of treatment, such as recurrent hospitalization, loss of autonomy in daily activities, loss of contact with grandchildren and loss of cognitive functions. Interventions oriented to vulnerabilities detected in the older patients (by comprehensive geriatric assessment) and an optimal approach, including preventive measures to reduce treatment-related toxicity and mortality, are directly correlated to improvement in quality of life.
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Affiliation(s)
| | | | | | - Dominique Bron
- Department of Hematology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium; (F.M.); (F.A.); (C.V.)
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Perissinotti AJ, Bishop MR, Bubalo J, Geyer MB, Goodrich A, Howard SC, Kula J, Mandayam S, Cairo MS, Pui CH. Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: Results of a modified Delphi panel. Cancer Treat Rev 2023; 120:102603. [PMID: 37579533 DOI: 10.1016/j.ctrv.2023.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Tumor lysis syndrome (TLS), which occurs spontaneously or in response to anticancer treatment, results in the release of intracellular potassium, phosphorus, and nucleic acids into the bloodstream, which results in secondary clinical complications that may be fatal. Prior TLS guidelines do not take into consideration potent novel oncologic agents or contemporary treatment paradigms with increased risk of TLS. Thus, a modified Delphi panel of experts was convened to provide an update for TLS management guidelines based upon a combination of supporting literature and practice consensus. METHODS A three-round modified Delphi process was implemented. For round 1, nine expert panelists completed a web-based questionnaire developed using published literature. In round 2, panelists were asked to reconsider their answers to questions that did not reach consensus (defined as ≥ 66% agreement among voting panelists). Round 3 was an unblinded, moderated virtual meeting to discuss any remaining questions that did not reach consensus. RESULTS Detailed recommendations are given for prophylaxis, monitoring, and management of TLS risks and complications, with hydration being a key element of TLS prophylaxis and management. Guidelines for the management of acute effects of TLS and prevention of long-term renal effects include management of hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia. DISCUSSION Although the control of uric acid levels is quite effective with currently available agents, panelists emphasize the importance of monitoring and treating other dangerous electrolyte abnormalities such as hyperkalemia and hyperphosphatemia. Guidelines from this modified Delphi panel should aid clinicians in preventing and managing TLS.
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Affiliation(s)
- Anthony J Perissinotti
- University of Michigan Health - Michigan Medicine, Department of Pharmacy, Ann Arbor, MI 48109, USA
| | - Michael R Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Joseph Bubalo
- Department of Pharmacy/Division of Hematology and Medical Oncology, OHSU Hospital and Clinics, Pharmacy Services, Portland, OR 97239, USA
| | - Mark B Geyer
- Leukemia and Cell Therapy Services, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Amy Goodrich
- Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21231, USA
| | - Scott C Howard
- University of Tennessee Health Sciences Center, Memphis, TN 38103, USA
| | - Julianna Kula
- Rocky Mountain Cancer Centers, Greenwood Village, CO 80112, USA
| | - Sreedhar Mandayam
- Department of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mitchell S Cairo
- Department of Pediatrics, Cancer and Blood Diseases Center, New York Medical College, Valhalla, NY 10595, USA.
| | - Ching-Hon Pui
- Departments of Oncology, Global Pediatric Medicine, and Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Newbury P, Ganguly R, Henson C. Case Report: Tumor Lysis Syndrome After Quad Shot in Diffuse Large B-Cell Lymphoma. Adv Radiat Oncol 2023; 8:101265. [PMID: 37332529 PMCID: PMC10275961 DOI: 10.1016/j.adro.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Patrick Newbury
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ritvik Ganguly
- University of Oklahoma College of Medicine, Norman, Oklahoma
| | - Christina Henson
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Ruf T, Leonhardt A, Anz D, Kunz WG, Röhrle N, Foerster P, Tomsitz D, French LE, Seegräber M, Heinzerling L. Tumor lysis syndrome induced by tebentafusp. Immunotherapy 2023; 15:1363-1368. [PMID: 37661909 DOI: 10.2217/imt-2023-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Tebentafusp, a bispecific T-cell receptor fusion protein directed against gp100 and CD3, can improve survival in patients with metastatic uveal melanoma and was recently approved for the treatment of HLA-A*02:01-positive uveal melanoma patients. Since tebentafusp often induces cytokine-release syndrome, doses must be escalated and patients monitored as inpatients after the first infusions. The occurrence of tumor lysis syndrome, a potentially life-threatening condition, after administration of a single dose of tebentafusp, is reported here. With adequate therapy, including the application of rasburicase, the patient made a full recovery. It is important to raise awareness of the adverse event profile of this new therapeutic approach among healthcare professionals to promptly recognize and treat side effects.
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Affiliation(s)
- Theresa Ruf
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
| | - Anna Leonhardt
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
| | - David Anz
- Department of Internal Medicine, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Natascha Röhrle
- Department of Internal Medicine, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Paul Foerster
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Dirk Tomsitz
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
| | - Lars Einar French
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
- Dr. Philip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33125, USA
| | - Marlene Seegräber
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
| | - Lucie Heinzerling
- Department of Dermatology & Allergy, University Hospital, LMU Munich, Munich, 80337, Germany
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Kuwabara M, Fukuuchi T, Aoki Y, Mizuta E, Ouchi M, Kurajoh M, Maruhashi T, Tanaka A, Morikawa N, Nishimiya K, Akashi N, Tanaka Y, Otani N, Morita M, Miyata H, Takada T, Tsutani H, Ogino K, Ichida K, Hisatome I, Abe K. Exploring the Multifaceted Nexus of Uric Acid and Health: A Review of Recent Studies on Diverse Diseases. Biomolecules 2023; 13:1519. [PMID: 37892201 PMCID: PMC10604821 DOI: 10.3390/biom13101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
The prevalence of patients with hyperuricemia or gout is increasing worldwide. Hyperuricemia and gout are primarily attributed to genetic factors, along with lifestyle factors like consuming a purine-rich diet, alcohol and/or fructose intake, and physical activity. While numerous studies have reported various comorbidities linked to hyperuricemia or gout, the range of these associations is extensive. This review article focuses on the relationship between uric acid and thirteen specific domains: transporters, genetic factors, diet, lifestyle, gout, diabetes mellitus, metabolic syndrome, atherosclerosis, hypertension, kidney diseases, cardiovascular diseases, neurological diseases, and malignancies. The present article provides a comprehensive review of recent developments in these areas, compiled by experts from the Young Committee of the Japanese Society of Gout and Uric and Nucleic Acids. The consolidated summary serves to enhance the global comprehension of uric acid-related matters.
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Affiliation(s)
- Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, 2-2-2-Toranomon, Minato, Tokyo 105-8470, Japan
| | - Tomoko Fukuuchi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Itabashi, Tokyo 173-8605, Japan;
| | - Yuhei Aoki
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, Kagawa, Japan;
| | - Einosuke Mizuta
- Department of Cardiology, Sanin Rosai Hospital, Yonago 683-8605, Tottori, Japan;
| | - Motoshi Ouchi
- Department of Health Promotion in Nursing and Midwifery, Innovative Nursing for Life Course, Graduate School of Nursing, Chiba University, Chiba 260-8672, Chiba, Japan;
- Department of Pharmacology and Toxicology, School of Medicine, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka 5454-8585, Osaka, Japan;
| | - Tatsuya Maruhashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Hiroshima, Japan;
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga 849-8501, Saga, Japan;
| | - Nagisa Morikawa
- Division of Cardio-Vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan;
- Department of Community Medicine, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Hospital, Sendai 980-8574, Miyagi, Japan;
| | - Naoyuki Akashi
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Saitama, Japan;
| | - Yoshihiro Tanaka
- Division of Epidemiology, Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka 420-0881, Shizuoka, Japan;
| | - Naoyuki Otani
- Cardiovascular Center, Dokkyo Medical University Nikko Medical Center, Nikko 321-1298, Tochigi, Japan;
| | - Mihoko Morita
- Department of Hematology and Oncology, University of Fukui Hospital, Eiheiji 910-1193, Fukui, Japan;
| | - Hiroshi Miyata
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo, Tokyo 113-8655, Japan; (H.M.); (T.T.)
| | - Tappei Takada
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo, Tokyo 113-8655, Japan; (H.M.); (T.T.)
| | - Hiroshi Tsutani
- National Hospital Organization Awara Hospital, Awara 910-4272, Fukui, Japan;
| | - Kazuhide Ogino
- Department of Cardiology, Japanese Red Cross Tottori Hospital, Tottori 680-8517, Tottori, Japan;
| | - Kimiyoshi Ichida
- Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan;
| | - Ichiro Hisatome
- National Hospital Organization Yonago Medical Center, Yonago 683-0006, Tottori, Japan;
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Fukuoka, Japan;
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Chaba A, Fodil S, Lemiale V, Mariotte E, Valade S, Azoulay E, Zafrani L. Clinical Warburg effect in lymphoma patients admitted to intensive care unit. Ann Intensive Care 2023; 13:97. [PMID: 37796407 PMCID: PMC10555986 DOI: 10.1186/s13613-023-01192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The Warburg effect, characterized by elevated lactate levels without tissue hypoxia or shock, has been described in patients with aggressive lymphoproliferative malignancies. However, the clinical characteristics and long-term outcomes in this population remain poorly understood. METHODS We retrospectively analyzed 135 patients with aggressive lymphoproliferative malignancies admitted to the ICU between January 2017 and December 2022. Patients were classified into three groups: Clinical Warburg Effect (CWE), No Warburg with High Lactate level (NW-HL), and No Warburg with Normal Lactate level (NW-NL). Clinical characteristics and outcomes were compared between the groups and factors associated with 1-year mortality and CWE were identified using multivariable analyses. RESULTS Of the 135 patients, 46 (34%) had a CWE. This group had a higher proportion of Burkitt and T cell lymphomas, greater tumor burden, and more frequent bone and cerebral involvement than the other groups. At 1 year, 72 patients (53%) died, with significantly higher mortality in the CWE and NW-HL groups (70% each) than in the NW-NL group (38%). Factors independently associated with 1-year mortality were age [HR = 1.02 CI 95% (1.00-1.04)], total SOFA score at admission [HR = 1.19 CI 95% (1.12-1.25)], and CWE [HR = 3.87 CI 95% (2.13-7.02)]. The main factors associated with the CWE were tumor lysis syndrome [OR = 2.84 CI 95% (1.14-7.42)], bone involvement of the underlying malignancy [OR = 3.58 CI 95% (1.02-12.91)], the total SOFA score at admission [OR = 0.81 CI 95% (0.69-0.91)] and hypoglycemia at admission [OR = 14.90 CI 95% (5.42-47.18)]. CONCLUSION CWE is associated with a higher tumor burden and increased 1-year mortality compared to patients without this condition. Our findings underscore the importance of recognizing patients with CWE as a high-risk cohort, as their outcomes closely resemble those of individuals with lymphoma and shock, despite not requiring advanced organ support. Clinicians should recognize the urgency of managing these patients and consider early intervention to improve their prognosis.
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Affiliation(s)
- Anis Chaba
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sofiane Fodil
- Department of Hematology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France
- University Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
- University Paris Cité, Paris, France.
- INSERM, UMR 944, University Paris Cité, Paris, France.
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Wei Z, Xu J, Zhao C, Zhang M, Xu N, Kang L, Lou X, Yu L, Feng W. Prediction of severe CRS and determination of biomarkers in B cell-acute lymphoblastic leukemia treated with CAR-T cells. Front Immunol 2023; 14:1273507. [PMID: 37854590 PMCID: PMC10579557 DOI: 10.3389/fimmu.2023.1273507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction CAR-T cell therapy is a novel approach in the treatment of hematological tumors. However, it is associated with life-threatening side effects, such as the severe cytokine release syndrome (sCRS). Therefore, predicting the occurrence and development of sCRS is of great significance for clinical CAR-T therapy. The study of existing clinical data by artificial intelligence may bring useful information. Methods By analyzing the heat map of clinical factors and comparing them between severe and non-severe CRS, we can identify significant differences among these factors and understand their interrelationships. Ultimately, a decision tree approach was employed to predict the timing of severe CRS in both children and adults, considering variables such as the same day, the day before, and initial values. Results We measured cytokines and clinical biomarkers in 202 patients who received CAR-T therapy. Peak levels of 25 clinical factors, including IFN-γ, IL6, IL10, ferritin, and D-dimer, were highly associated with severe CRS after CAR T cell infusion. Using the decision tree model, we were able to accurately predict which patients would develop severe CRS consisting of three clinical factors, classified as same-day, day-ahead, and initial value prediction. Changes in serum biomarkers, including C-reactive protein and ferritin, were associated with CRS, but did not alone predict the development of severe CRS. Conclusion Our research will provide significant information for the timely prevention and treatment of sCRS, during CAR-T immunotherapy for tumors, which is essential to reduce the mortality rate of patients.
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Affiliation(s)
- Zhenyu Wei
- Intelligent Systems Science and Engineering College, Harbin Engineering University, Harbin, China
| | - Jiayu Xu
- Intelligent Systems Science and Engineering College, Harbin Engineering University, Harbin, China
| | - Chengkui Zhao
- Intelligent Systems Science and Engineering College, Harbin Engineering University, Harbin, China
- Shanghai Unicar-Therapy BioMedicine Technology Co., Ltd, Shanghai, China
| | - Min Zhang
- Intelligent Systems Science and Engineering College, Harbin Engineering University, Harbin, China
| | - Nan Xu
- Shanghai Unicar-Therapy BioMedicine Technology Co., Ltd, Shanghai, China
- School of Chemical and Molecular Engineering, East China Normal University, Shanghai, China
| | - Liqing Kang
- Shanghai Unicar-Therapy BioMedicine Technology Co., Ltd, Shanghai, China
- School of Chemical and Molecular Engineering, East China Normal University, Shanghai, China
| | - Xiaoyan Lou
- Shanghai Unicar-Therapy BioMedicine Technology Co., Ltd, Shanghai, China
- School of Chemical and Molecular Engineering, East China Normal University, Shanghai, China
| | - Lei Yu
- Shanghai Unicar-Therapy BioMedicine Technology Co., Ltd, Shanghai, China
- School of Chemical and Molecular Engineering, East China Normal University, Shanghai, China
| | - Weixing Feng
- Intelligent Systems Science and Engineering College, Harbin Engineering University, Harbin, China
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Battah A, Farouji I, DaCosta TR, Ghandi D, DaCosta T, Bains Y. Beyond the Expectation: Pembrolizumab-Associated Tumor Lysis Syndrome in Metastatic Gastric Adenocarcinoma. Cureus 2023; 15:e48024. [PMID: 38034230 PMCID: PMC10688220 DOI: 10.7759/cureus.48024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Tumor lysis syndrome (TLS) emerges as a critical oncological emergency, a consequence of the body's struggle to manage the intense cellular turnover and release of cytotoxins induced by treatments such as chemotherapy, radiation, targeted immune therapy, or hormonal therapy. While commonly associated with hematological malignancies, the heightened risk also extends to advanced-stage solid tumors and instances of liver metastasis. Although TLS is a rare occurrence in gastric adenocarcinoma, reported cases are usually linked to the initiation of chemotherapy. Remarkably, the incidence of TLS following the commencement of pembrolizumab in gastric adenocarcinoma remains undocumented in the existing literature. In this context, we present a compelling case involving a 73-year-old gentleman diagnosed with advanced-stage metastatic gastric adenocarcinoma. Strikingly, the patient developed TLS subsequent to the initiation of pembrolizumab (Keytruda®). This unique scenario not only accentuates the atypical manifestation of TLS in the context of gastric adenocarcinoma but also underscores the need for heightened awareness and exploration of potential complications associated with immunotherapeutic agents in solid tumor settings. The detailed analysis of this case contributes valuable insights that may prove instrumental in refining our understanding of the intricate interplay between immunotherapy and tumor lysis syndrome in the specific landscape of gastric adenocarcinoma.
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Affiliation(s)
- Arwa Battah
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Iyad Farouji
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Theodore R DaCosta
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Darshan Ghandi
- Internal Medicine, Saint Marys General Hospital, Passiac, USA
| | - Theodore DaCosta
- Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, USA
| | - Yatinder Bains
- Gastroenterology, New York Medical College at Saint Michael's Medical Center, Newark, USA
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Mahfooz K, Sohail H, Gvajaia A, Arif U, Grewal D, Muppidi MR, Vohra V, Tarique A, Vasavada A. Rasburicase in treating tumor lysis syndrome: An umbrella review. CANCER PATHOGENESIS AND THERAPY 2023; 1:262-271. [PMID: 38327601 PMCID: PMC10846299 DOI: 10.1016/j.cpt.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 02/09/2024]
Abstract
Tumor lysis syndrome (TLS) remains a debilitating cause of hospitalization and death in patients with cancer and is a significant challenge for healthcare providers despite advancements in its management. This umbrella review analyzed the results of meta-analyses on the use of rasburicase in the treatment of patients with cancer. A literature search was performed of five databases (PubMed, Google Scholar, Cochrane Library, Scopus, Global Index Medicus, and ScienceDirect) for articles with full texts available online. A measurement tool to assess systematic reviews 2 (AMSTAR 2) was used to assess the quality of the included studies, and Review Manager software was used to conduct all statistical analyses. The systematic search identified eight relevant meta-analyses, with primary analyses including outcome data that analyzed mortality, renal failure, and comparisons with allopurinol. The pooled data showed that rasburicase effectively reduced TLS development and serum uric acid levels in children and adults with malignancies. Most outcomes did not differ significantly compared with those of allopurinol. Future trials should focus on the cost-effectiveness of rasburicase compared to that of allopurinol while including high-, intermediate-, and low-risk patients. Rasburicase is safe and effective for managing patients with TLS. However, recent large-scale meta-analyses have reported conflicting results. Most meta-analyses were graded as low to critically low as per AMSTAR 2. The analysis revealed that the benefit of rasburicase did not differ significantly from that of allopurinol, which has higher cost-effectiveness and fewer side effects.
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Affiliation(s)
- Kamran Mahfooz
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Haris Sohail
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Ani Gvajaia
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Uroosa Arif
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Daisy Grewal
- Department of Internal Medicine, St. Georges University, St. Georges, Grenada
| | - Monica Reddy Muppidi
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Vanya Vohra
- Department of Pediatrics, St Barnabas Hospital, Bronx, NY, 10457, USA
| | - Aamir Tarique
- Department of Medicine, ESIC Medical College, Faridabad, 121001, India
| | - Advait Vasavada
- Department of Medicine, MP Shah Medical College, Jamnagar, 361008, India
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Sebbens D, Spruit JL. Hematologic and Oncologic Emergencies in the Pediatric Intensive Care Unit: What Nurses Should Know. Crit Care Nurs Clin North Am 2023; 35:303-314. [PMID: 37532384 DOI: 10.1016/j.cnc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Most children admitted to the pediatric intensive care unit with a new or reoccurring hematology or oncology diagnosis are at high risk for developing a hematologic or oncologic emergency. Although these children represent a low percentage of pediatric critical care admissions, their acuity is high, and their care is complicated and challenging. Nurses are an essential part of the interprofessional team of providers who care for these critically ill patients. Experience recognizing acute decompensation and excellent assessment and communication skills significantly improve patient outcomes.
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Affiliation(s)
- Danielle Sebbens
- Arizona State University, Edson College of Nursing and Health Innovation, 500 North 3rd Street, Phoenix, AZ 85004-0698, USA; Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
| | - Jessica L Spruit
- Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
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Heger JM, Böll B, Naendrup JH, Simon F, Gräf CM, Hallek M, Shimabukuro-Vornhagen A, Kochanek M, Eichenauer DA, Garcia Borrega J. Hyperleukocytosis in patients with acute myeloid leukemia admitted to the intensive care unit: a single-center retrospective analysis. Leuk Res 2023; 132:107352. [PMID: 37423072 DOI: 10.1016/j.leukres.2023.107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
A relevant proportion of patients with acute myeloid leukemia (AML) presenting with hyperleukocytosis are admitted to the intensive care unit (ICU). However, data on characteristics and outcomes of these patients are limited. We therefore conducted a single-center retrospective analysis including 69 consecutive AML patients with a white blood cell (WBC) count > 100.000/µl who had been treated on the ICU between 2011 and 2020. The median age was 63 years (range: 14-87 years). Males accounted for the majority of cases (n = 43; 62.3%). Mechanical ventilation (MV), renal replacement therapy and the use of vasopressors were necessary in 34.8%, 8.7% and 40.6% of patients, respectively. Cardiopulmonary resuscitation was performed in 15.9% of patients. The ICU, hospital, 90-day and 1-year survival rates were 53.6%, 43.5%, 42% and 30.4%, respectively. Age (p = 0.002), SOFA score (p < 0.001) and MV (p < 0.001) were independently associated with a reduced survival probability. A score comprising the factors age > 70 years, lactate dehydrogenase level > 1500 U/l, WBC count > 150.000/µl, elevated lactate level and SOFA score > 7 allowed the discrimination of 3 distinct risk groups (low-risk: 0-1 points, intermediate-risk: 2 points, high-risk: 3-5 points) with regard to survival (p < 0.0001). Taken together, the present analysis indicates that more than two-thirds of AML patients with hyperleukocytosis treated on the ICU die within 1 year. However, outcomes vary considerably depending on the presence of risk factors.
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Affiliation(s)
- Jan-Michel Heger
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Boris Böll
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Jan-Hendrik Naendrup
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Florian Simon
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claus Moritz Gräf
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Michael Hallek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Matthias Kochanek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany.
| | - Jorge Garcia Borrega
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
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De Leo S, Trevisan M, Re Sartò GV, Moneta C, Pirovano M, Colombo C, Cosmai L, Fugazzola L. Letter to the Editor: Tumor Lysis Syndrome During Selpercatinib Treatment in a Patient with Medullary Thyroid Cancer. Thyroid 2023; 33:1130-1132. [PMID: 37463111 DOI: 10.1089/thy.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Simone De Leo
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Matteo Trevisan
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Giulia Vanessa Re Sartò
- Division of Nephrology and Dialysis, ASST Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Claudia Moneta
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Marta Pirovano
- Division of Nephrology and Dialysis, ASST Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Carla Colombo
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Laura Cosmai
- Division of Nephrology and Dialysis, ASST Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Song SM, Jeon J, Jang HR, Kim K, Huh W, Kim YG, Lee JE. Acute kidney injury in bortezomib-treated patients with multiple myeloma. Nephrol Dial Transplant 2023; 38:2077-2085. [PMID: 36662030 DOI: 10.1093/ndt/gfad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been elucidated, although tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been reported to increase after introduction of the drug. This study compared the incidence and risk factors for acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate drug-related nephrotoxicity. METHODS From 2006 to 2017, 276 patients who underwent a first cycle of bortezomib-based chemotherapy for MM were identified in a single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network criteria within 7 days of the first chemotherapy. RESULTS The median (interquartile range) age was 65 (56-72) years, and baseline estimated glomerular filtration rate (eGFR) was 61.3 (34.1-89.1) mL/min/1.73 m2. The incidences of AKI and laboratory TLS were 17% (n = 47) and 13% (n = 36), respectively. Ten (3.6%) subjects met both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category [30-59, odds ratio (OR) 3.005 (95% confidence interval 1.163-7.976); 15-29, OR 4.225 (1.183-15.000); <15, OR 16.154 (3.831-70.920) vs ≥60, P < .001], lower serum albumin level [per 1 increase, OR 0.479 (0.256-0.871), P = .018], renal amyloidosis [OR 13.039 (4.108-44.041), P < .001] and use of acyclovir during bortezomib treatment [OR 3.689 (1.133-14.469), P = .042] were predictors of AKI. MM stages and β-2-microglobulin were not associated with increased risk of AKI. Regarding laboratory TLS, MM stage and β-2-microglobulin were higher in those with TLS than in others. In multivariate analyses, β-2-microglobulin level [OR 1.204 (1.005-1.461), P = .038] and absence of high-risk chromosome abnormalities [OR 0.143 (0.022-0.588), P = .016] were associated with higher risk of TLS. CONCLUSIONS Development of AKI was often observed in the absence of TLS in patients with MM after treatment with bortezomib. In addition, the risk factors for AKI and TLS varied widely. These findings indicate the potential nephrotoxicity of bortezomib irrespective of TLS in patients with decreased kidney function.
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Affiliation(s)
- Seung Min Song
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junseok Jeon
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Ryoun Jang
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kihyun Kim
- Hematology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wooseong Huh
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-Goo Kim
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Lee
- Nephrology Division; Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Anderson A, Shoulders L, James V, Ashcraft E, Cheng C, Ribeiro R, Elbahlawan L. Benefit of continuous kidney replacement therapy for managing tumor lysis syndrome in children with hematologic malignancies. Front Oncol 2023; 13:1234677. [PMID: 37664024 PMCID: PMC10471890 DOI: 10.3389/fonc.2023.1234677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Tumor lysis syndrome (TLS) is often diagnosed in children with hematological malignancies and can be life threatening due to metabolic disturbances. Continuous renal replacement therapy (CKRT) can reverse these disturbances relatively quickly when conventional medical management fails. Our objective was to investigate the benefit of CKRT in the management of TLS in children admitted to the intensive care unit with hematologic malignancies. In addition, we sought to assess risk factors for acute kidney injury (AKI) in the setting of TLS. Methods Retrospective review of all children admitted to the intensive care unit with TLS who received CKRT from January 2012 to August 2022. Results Among 222 children hospitalized with TLS from January 2012 to August 2022, 20 (9%) underwent CKRT to manage TLS in the intensive care unit. The patients' median age was 13 years (range 3-17 y), and most were males (18/20). T-cell acute lymphoblastic leukemia was the most common diagnosis (n=10), followed by acute myeloid leukemia (n=4), Burkitt lymphoma (n=4), and B-cell acute lymphoblastic leukemia (n=2). Five patients required mechanical ventilation, and 2 required vasopressors. The most common indication for CKRT was hyperphosphatemia, followed by, hyperuricemia, and hyperkalemia. All metabolic abnormalities corrected within 12 h of initiation of CKRT. CKRT courses were brief, with a median duration of 2 days (range 1-7 days). Having higher serum phosphorus levels 12 h preceding CKRT was significantly associated with severe acute kidney injury (AKI). The median phosphorus level was 6.4 mg/dL in children with no/mild AKI and 10.5 mg/dL in children with severe AKI (p=0.0375). Serum uric acid levels before CKRT were not associated with AKI. All children survived to hospital discharge, and the one-year survival rate was 90%. Conclusion CKRT is safe in children with hematologic malignancies with severe TLS and reverses metabolic derangements within 6-12 h. Most patients had AKI at the initiation of CKRT but did not require long-term kidney replacement therapy. Hyperphosphatemia before initiation of CKRT is associated with higher risk of AKI.
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Affiliation(s)
- Ashlea Anderson
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Laurie Shoulders
- Department of Nursing, Intensive Care Unit, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Vinson James
- Division of Pediatric Nephrology, Department of Pediatrics, LeBonheur Children's Hospital, Memphis, TN, United States
| | - Emily Ashcraft
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Raul Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lama Elbahlawan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
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Schubert ML, Schmitt A, Hückelhoven-Krauss A, Neuber B, Kunz A, Waldhoff P, Vonficht D, Yousefian S, Jopp-Saile L, Wang L, Korell F, Keib A, Michels B, Haas D, Sauer T, Derigs P, Kulozik A, Kunz J, Pavel P, Laier S, Wuchter P, Schmier J, Bug G, Lang F, Gökbuget N, Casper J, Görner M, Finke J, Neubauer A, Ringhoffer M, Wolleschak D, Brüggemann M, Haas S, Ho AD, Müller-Tidow C, Dreger P, Schmitt M. Treatment of adult ALL patients with third-generation CD19-directed CAR T cells: results of a pivotal trial. J Hematol Oncol 2023; 16:79. [PMID: 37481608 PMCID: PMC10363324 DOI: 10.1186/s13045-023-01470-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Third-generation chimeric antigen receptor (CAR)-engineered T cells (CARTs) might improve clinical outcome of patients with B cell malignancies. This is the first report on a third-generation CART dose-escalating, phase-1/2 investigator-initiated trial treating adult patients with refractory and/or relapsed (r/r) acute lymphoblastic leukemia (ALL). METHODS Thirteen patients were treated with escalating doses of CD19-directed CARTs between 1 × 106 and 50 × 106 CARTs/m2. Leukapheresis, manufacturing and administration of CARTs were performed in-house. RESULTS For all patients, CART manufacturing was feasible. None of the patients developed any grade of Immune effector cell-associated neurotoxicity syndrome (ICANS) or a higher-grade (≥ grade III) catokine release syndrome (CRS). CART expansion and long-term CART persistence were evident in the peripheral blood (PB) of evaluable patients. At end of study on day 90 after CARTs, ten patients were evaluable for response: Eight patients (80%) achieved a complete remission (CR), including five patients (50%) with minimal residual disease (MRD)-negative CR. Response and outcome were associated with the administered CART dose. At 1-year follow-up, median overall survival was not reached and progression-free survival (PFS) was 38%. Median PFS was reached on day 120. Lack of CD39-expression on memory-like T cells was more frequent in CART products of responders when compared to CART products of non-responders. After CART administration, higher CD8 + and γδ-T cell frequencies, a physiological pattern of immune cells and lower monocyte counts in the PB were associated with response. CONCLUSION In conclusion, third-generation CARTs were associated with promising clinical efficacy and remarkably low procedure-specific toxicity, thereby opening new therapeutic perspectives for patients with r/r ALL. Trial registration This trial was registered at www. CLINICALTRIALS gov as NCT03676504.
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Affiliation(s)
- Maria-Luisa Schubert
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Angela Hückelhoven-Krauss
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Brigitte Neuber
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Alexander Kunz
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip Waldhoff
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dominik Vonficht
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany
- Division of Stem Cells and Cancer, Deutsches Krebsforschungszentrum (DKFZ) and DKFZ-ZMBH Alliance, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Schayan Yousefian
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - Lea Jopp-Saile
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany
- Division of Stem Cells and Cancer, Deutsches Krebsforschungszentrum (DKFZ) and DKFZ-ZMBH Alliance, Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Lei Wang
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Felix Korell
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anna Keib
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Michels
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dominik Haas
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Tim Sauer
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Patrick Derigs
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas Kulozik
- Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Kunz
- Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Petra Pavel
- Institute for Clinical Transfusion Medicine and Cell Therapy (IKTZ), German Red Cross Blood Service Baden-Württemberg-Hessen, Heidelberg, Germany
| | - Sascha Laier
- Institute for Clinical Transfusion Medicine and Cell Therapy (IKTZ), German Red Cross Blood Service Baden-Württemberg-Hessen, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, of the Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | | | - Gesine Bug
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Fabian Lang
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Nicola Gökbuget
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Jochen Casper
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Martin Görner
- Department of Hematology and Oncology, Hospital Bielefeld, Bielefeld, Germany
| | - Jürgen Finke
- Department of Internal Medicine I, University Hospital Freiburg, Freiburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Giessen und Marburg, Marburg, Germany
| | | | - Denise Wolleschak
- Department of Hematology and Oncology, Center of Internal Medicine, Otto-von-Guericke University Medical Center, Magdeburg, Germany
| | - Monika Brüggemann
- Department of Internal Medicine II, University Hospital Kiel, Kiel, Germany
| | - Simon Haas
- Heidelberg Institute for Stem Cell Technology and Experimental Medicine (HI-STEM gGmbH), Heidelberg, Germany
- Division of Stem Cells and Cancer, Deutsches Krebsforschungszentrum (DKFZ) and DKFZ-ZMBH Alliance, Heidelberg, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)/National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anthony D Ho
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)/National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)/National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)/National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)/National Center for Tumor Diseases (NCT), Heidelberg, Germany.
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Papapanou M, Athanasopoulos AE, Georgiadi E, Maragkos SA, Liontos M, Ziogas DC, Damaskos D, Schizas D. Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature. Med Oncol 2023; 40:233. [PMID: 37432468 PMCID: PMC10335952 DOI: 10.1007/s12032-023-02108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.
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Affiliation(s)
- Michail Papapanou
- Society of Junior Doctors, Athens, 15123, Greece.
- Second Department of Obstetrics and Gynecology, Medical School, "Aretaieion Hospital", National and Kapodistrian University of Athens, 76 Vas. Sofias Ave, Athens, 11528, Greece.
| | | | - Eleni Georgiadi
- 2nd Department of Radiology, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens, 1 Rimini Str, Haidari/Athens, 12462, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | | | - Michalis Liontos
- Department of Clinical Therapeutics, Division of Oncology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas. Sofias Ave, Athens, 10679, Greece
| | - Dimitrios C Ziogas
- First Department of Internal Medicine, Unit of Medical Oncology, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
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Sawalha Y, Goyal S, Switchenko JM, Romancik JT, Kamdar M, Greenwell IB, Hess BT, Isaac KM, Portell CA, Mejia Garcia A, Goldsmith S, Grover NS, Riedell PA, Karmali R, Burkart M, Buege M, Akhtar O, Torka P, Kumar A, Hill BT, Kahl BS, Cohen JB. A multicenter analysis of the outcomes with venetoclax in patients with relapsed mantle cell lymphoma. Blood Adv 2023; 7:2983-2993. [PMID: 36809796 PMCID: PMC10320213 DOI: 10.1182/bloodadvances.2022008916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
To report the activity of venetoclax in patients with relapsed mantle cell lymphoma (MCL), we identified 81 patients treated with venetoclax monotherapy (n = 50, 62%) or in combination with a Bruton tyrosine kinase inhibitor (BTKi) (n = 16, 20%), an anti-CD20 monoclonal antibody (n = 11, 14%), or other active agents at 12 US academic medical centers. Patients had high-risk disease features including Ki67 >30% (61%), blastoid/pleomorphic histology (29%), complex karyotype (34%), and TP53 alterations (49%), and received a median of 3 prior treatments including BTKis in 91%. Venetoclax alone or in combination resulted in an overall response rate (ORR) of 40% and median progression-free (PFS) and overall survival (OS) of 3.7 and 12.5 months, respectively. The receipt of ≤3 prior treatments was associated with higher odds of response to venetoclax in a univariable analysis. In a multivariable analysis, having a high-risk Mantle Cell Lymphoma International Prognostic Index score before receiving venetoclax and disease relapse or progression within 24 months of diagnosis were associated with inferior OS whereas the use of venetoclax in combination was associated with superior OS. Although most patients (61%) had low risk for tumor lysis syndrome (TLS), 12.3% of patients developed TLS despite the implementation of several mitigation strategies. In conclusion, venetoclax resulted in good ORR but short PFS in patients with MCL who are at high risk, and may have a better role in earlier lines of treatment and/or in conation with other active agents. TLS remains an important risk in patients with MCL who initiate treatment with venetoclax.
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Affiliation(s)
- Yazeed Sawalha
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jason T. Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Manali Kamdar
- Division of Hematology, University of Colorado Denver, Denver, CO
| | - I. Brian Greenwell
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Brian T. Hess
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC
| | - Krista M. Isaac
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Craig A. Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | | | - Scott Goldsmith
- Department of Medicine, Washington University School of Medicine, Washington University, St. Louis, MO
| | | | - Peter A. Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Madelyn Burkart
- Division of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Michael Buege
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Othman Akhtar
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anita Kumar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Brad S. Kahl
- Department of Medicine, Washington University School of Medicine, Washington University, St. Louis, MO
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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50
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Kittivisuit S, Jongthitinon N, Sripornsawan P, Songthawee N, Chavananon S, Limratchapong C, McNeil EB, Chotsampancharoen T. Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes. Cancers (Basel) 2023; 15:3072. [PMID: 37370683 DOI: 10.3390/cancers15123072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Hyperleukocytosis and extreme hyperleukocytosis, defined as initial white blood cell counts greater than 100 × 109/L and 200 × 109/L, respectively, have been associated with unfavorable outcomes. This study aimed to determine the early complications and survival outcomes of childhood leukemia patients with hyperleukocytosis. The medical records of 690 children newly diagnosed with acute leukemia between January 1998 and December 2017 were retrospectively reviewed. The Kaplan-Meier method and log-rank test were used to assess and compare the survival outcomes. Multivariate Cox proportional hazards regression was used to determine associated risk factors for overall survival. We found that 16.6% of 483 childhood acute lymphoblastic leukemia (ALL) patients and 20.3% of 207 childhood acute myeloid leukemia (AML) patients had hyperleukocytosis at diagnosis. ALL patients with hyperleukocytosis had more early complications than those without hyperleukocytosis (p < 0.05). Among the ALL group, the 5-year overall survival rate for those with hyperleukocytosis was significantly lower than for those without hyperleukocytosis (37.2% vs. 67.8%, p < 0.0001), while the difference was not statistically significant in the AML group (19.0% vs. 30.2%, respectively, p = 0.26). Hyperleukocytosis (hazard ratio [HR]: 2.04), extreme hyperleukocytosis (HR: 2.71), age less than 1 year (HR: 3.05), age greater than 10 years (HR: 1.64), and male sex (HR: 1.37) were independently associated with poorer overall survival in childhood ALL patients. Extreme hyperleukocytosis (HR: 2.63) and age less than 1 year (HR: 1.82) were independently associated with poorer overall survival in AML patients. Hyperleukocytosis was associated with adverse survival outcomes in childhood leukemia.
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Affiliation(s)
- Sirinthip Kittivisuit
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Nichanan Jongthitinon
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Pornpun Sripornsawan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Natsaruth Songthawee
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Shevachut Chavananon
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Chompoonut Limratchapong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
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