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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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Parajuli A, Chinnappan J, Azher Q, Bachuwa G, Mcdonald PJ. Methotrexate-Induced Lymphoproliferative Disorder Complicating Into Spontaneous Tumor Lysis Syndrome and Disseminated Intravascular Coagulation. Cureus 2023; 15:e40665. [PMID: 37485199 PMCID: PMC10356908 DOI: 10.7759/cureus.40665] [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: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Lymphoproliferative disorder (LPD) is a severe adverse outcome of methotrexate (MTX) administration in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The immunosuppression caused is attributed to pathogenesis. Hence, discontinuation is the treatment. Reports on spontaneous tumor lysis with cessation of MTX are rare. We report a case of a female in her 50s with methotrexate-associated lymphoproliferative disease (MTX-LPD) following treatment for rheumatoid arthritis. Methotrexate was discontinued immediately. She presented two months later with severe disseminated intravascular coagulation (DIC) and spontaneous tumor lysis syndrome (STLS). Although tumor lysis syndrome responded well to rasburicase therapy, DIC was a challenge. MTX-LPD has various complications and highly variable presentation. RA/SLE patients receiving MTX should be regularly monitored, and MTX should be immediately stopped in suspicion of MTX-LPD. Although many patients respond to MTX cessation, some patients head to remission and relapse. At the same time, some worsen with complications such as DIC and tumor lysis syndrome, as described above. This case reiterates the need for regular monitoring following MTX therapy cessation for early identification and treatment of these complications to improve prognosis.
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Affiliation(s)
- Abinash Parajuli
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
| | | | - Qazi Azher
- Pathology and Laboratory Medicine, Hurley Medical Center, Flint, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
| | - Philip J Mcdonald
- Internal Medicine, Hurley Medical Center/Michigan State University, Flint, USA
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Aina DA, Erwin A, Li E, Manam R. A Rare Syndrome in a Rare Carcinoma: A Case of Spontaneous Tumor Lysis Syndrome in Small-Cell Liver Carcinoma. Cureus 2023; 15:e35455. [PMID: 36994306 PMCID: PMC10042309 DOI: 10.7759/cureus.35455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
Spontaneous tumor lysis syndrome (STLS) is a rare, oncologic emergency, consisting of life-threatening acute renal failure, hyperuricemia, hyperkalemia, and hyperphosphatemia, prior to the initiation of cytotoxic therapy. Here, we describe a case of STLS in a patient with newly diagnosed small-cell liver carcinoma (SCLC). A 64-year-old female with no significant past medical history presented with a one-month history of jaundice, pruritus, pale stools, dark urine, and right upper quadrant pain. CT of the abdomen revealed a heterogeneous-enhancing intrahepatic mass. CT-guided biopsy of the mass revealed SCLC. At follow-up, labs were significant for potassium 6.4 mmol/L, phosphorus 9.4 mg/dL, uric acid 21.4 mg/dL, calcium 9.0 mg/dL, and creatinine 6.9 mg/dL. She was admitted and treated with aggressive fluid rehydration and rasburicase, with eventual improvement in renal function and normalization of electrolytes and uric acid levels. On the rare occasion that STLS occurs in solid tumors, lung, colorectal, and melanoma are most common, with liver metastases occurring in 65% of cases. Our patient's SCLC was a primary liver malignancy with a large tumor burden, both of which may have predisposed her to develop STLS. Rasburicase is the first line in the treatment of acute tumor lysis syndrome as it quickly decreases uric acid. Identifying SCLC as a risk factor for STLS is key. Due to the high morbidity and mortality associated with this rare phenomenon, a prompt diagnosis is required.
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Shafie M, Shahmohamadi E, Ghasemi H, Zarei Jalalabadi N, Parsa S. Burkitt lymphoma presenting as cecum mass and spontaneous tumor lysis syndrome with hypercalcemia. Clin Case Rep 2023; 11:e6977. [PMID: 36846179 PMCID: PMC9950348 DOI: 10.1002/ccr3.6977] [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] [Received: 09/05/2022] [Revised: 12/08/2022] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Burkitt's lymphoma (BL) could be primarily presented with various symptoms. We reported a woman with abdominal pain and mass who later developed spontaneous TLS with hypercalcemia, and was diagnosed with BL. Clinicians should suspect BL in case of any abdominal mass, especially with an aggressive course, to avoid further complications.
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Affiliation(s)
- Mahan Shafie
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Hoomaan Ghasemi
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Narjes Zarei Jalalabadi
- Department of Internal Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Samaneh Parsa
- Department of Internal Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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Im D, Alsheimer K, Poulose J, Zeykan V, Talamo G. Relapse of Lung Adenocarcinoma Manifested by Spontaneous Tumor Lysis Syndrome. Case Rep Oncol 2023; 16:1306-1310. [PMID: 37942403 PMCID: PMC10629853 DOI: 10.1159/000534398] [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] [Received: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Tumor lysis syndrome (TLS) is an oncologic emergency characterized by several metabolic derangements, such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. TLS is typically observed in hematologic malignancies, especially after starting the first administration of antineoplastic therapies. TLS in a solid malignancy is very unusual, and exceedingly rare when occurring spontaneously, in the absence of chemotherapy. Case Presentation We report a case of a 76-year-old man with lung adenocarcinoma, which started as a cancer with indolent behavior and small tumor burden but relapsed in 5 months with rapidly proliferating metastatic disease. Spontaneous TLS was the presenting clinical manifestation of the tumor relapse, and it led to the patient's death. Conclusion To our knowledge, this is the first case of spontaneous TLS in a relapsed adenocarcinoma of the lung reported in the medical literature. The development of the metabolic derangements of TLS should prompt the consideration of tumor relapse during the follow-up of patients with solid malignancies.
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Affiliation(s)
- Daebin Im
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Katie Alsheimer
- Pulmonary and Critical Care, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Joyson Poulose
- Hematology-Oncology, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Violeta Zeykan
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Giampaolo Talamo
- Hematology-Oncology, Guthrie Robert Packer Hospital, Sayre, PA, USA
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Shafie M, Issaiy M, Barkhori M, Parsa S. Plasma cell leukemia presenting as spontaneous tumor lysis syndrome with hypercalcemia. Clin Case Rep 2022; 10:e05933. [PMID: 35846936 PMCID: PMC9281366 DOI: 10.1002/ccr3.5933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 12/16/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency in which tumor cells undergo lysis either spontaneously or due to the initiation of cancer therapy typically presenting with hypocalcemia. We described a 62‐year‐old male patient with spontaneous TLS and hypercalcemia without a known malignancy, who is later discovered to have plasma cell leukemia. A high level of suspicion is needed for spontaneous tumor lysis syndrome to be diagnosed in early stages to provide a better chance of more immediate and effective treatments, especially in invasive malignancies such as plasma cell leukemia.
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Affiliation(s)
- Mahan Shafie
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Department of Internal Medicine Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Mahbod Issaiy
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Mahdi Barkhori
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Samaneh Parsa
- Department of Internal Medicine Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
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Luminais SN, Chen XT, Roman D, Ma B, Christ AB, Hu JS. Tumor lysis syndrome following ifosfamide monotherapy in metastatic osteosarcoma: a case report and review of the literature. J Med Case Rep 2022; 16:252. [PMID: 35761364 PMCID: PMC9238137 DOI: 10.1186/s13256-022-03469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tumor lysis syndrome is an oncologic emergency that involves multiple metabolic abnormalities and clinical symptoms such as acute renal failure, cardiac arrhythmias, seizures, and multiorgan failure, and may be fatal if not promptly recognized. Tumor lysis syndrome occurs most often in patients with hematologic malignancies, and relatively few cases have been described in patients with sarcoma. Case presentation A 64-year-old male of Asian heritage presented to his primary care physician with a right lower-extremity mass and was ultimately diagnosed with widely metastatic osteosarcoma. He was treated with one cycle of cisplatin and doxorubicin that was complicated by hypervolemia and hypoxic respiratory failure. Given concerns for volume overload, therapy was changed to single-agent, dose-reduced ifosfamide. After receiving one dose of ifosfamide 1 g/m2 (1.8 g total) intravenously over 1 hour, the patient developed renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and lactic acidosis. The patient ultimately died from severe electrolyte abnormalities associated with tumor lysis syndrome. Conclusion This is the first instance of tumor lysis syndrome described in a patient with osteosarcoma undergoing ifosfamide monotherapy. Clinicians must be vigilant in identifying tumor lysis syndrome regardless of the malignancy type or chemotherapy regimen in order to prevent potentially fatal complications.
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Affiliation(s)
- Steven N Luminais
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Xiao T Chen
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Darwin Roman
- Department of Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Brian Ma
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - James S Hu
- Department of Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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