1
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Kaneko T, Miyazaki S, Kurita A, Morimoto R, Tsuchiya S, Watanabe N, Takaku T, Komatsu N, Minamino T. Endothelial function measured by peripheral arterial tonometry in patients with chronic myeloid leukemia on tyrosine kinase inhibitor therapy: a pilot study. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:11. [PMID: 36814340 PMCID: PMC9945366 DOI: 10.1186/s40959-023-00164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Arterial occlusive events are an emerging problem in patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitor (TKI) therapy. Endothelial cell damage is thought to play an important role in the development of vascular events. Measurement of the peripheral vasodilator response by peripheral arterial tonometry (PAT) has reportedly been useful in the non-invasive assessment of endothelial dysfunction. To date, no studies have assessed endothelial function using PAT in patients with CML receiving TKIs. METHOD We measured the reactive hyperemia index (RHI) using PAT in young patients with CML (men aged ≤ 55 years and women aged ≤ 65 years) receiving TKIs. RESULTS Thirty patients with CML were examined (mean age, 43.5 ± 9.8 years; men, 57%). The median RHI was 1.81. Among these patients, 16.7% and 83.3% were taking imatinib and second- or third-generation TKIs, respectively. There were no differences in the baseline characteristics between the low RHI (< 1.67, n = 10), borderline RHI (≥ 1.67 and < 2.10, n = 14), and normal RHI (≥ 2.10, n = 6) groups. Serum uric acid (UA) levels and the RHI were significantly negatively correlated (r = -0.40, p = 0.029). CONCLUSION One-third of young patients with CML receiving TKI therapy were classified as having a low RHI. The RHI was negatively correlated with serum UA level. Larger prospective studies are necessary to examine whether the RHI predicts cardiovascular events in such patients.
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Affiliation(s)
- Tomohiro Kaneko
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Azusa Kurita
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Ryoko Morimoto
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Shun Tsuchiya
- grid.258269.20000 0004 1762 2738Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Naoki Watanabe
- grid.258269.20000 0004 1762 2738Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Tomoiku Takaku
- grid.258269.20000 0004 1762 2738Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Norio Komatsu
- grid.258269.20000 0004 1762 2738Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
| | - Tohru Minamino
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo Japan
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2
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Psomadakis CE, Maron SZ, Ng MJ, Kessler AJ, Bryce CH, Shanker VL, Scelsa SN. Anti-TIF-1α/γ Antibody-Positive Dermatomyositis Associated With Metastatic Prostatic Adenocarcinoma. J Clin Neuromuscul Dis 2021; 23:100-104. [PMID: 34808651 DOI: 10.1097/cnd.0000000000000378] [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: 06/13/2023]
Abstract
Dermatomyositis (DM) is an autoimmune myopathy characterized by proximal muscle weakness and distinct skin findings. DM is associated with an increased risk of malignancy in adults. We describe a case of dermatomyositis with unusually severe oropharyngeal dysphagia and respiratory muscle weakness on presentation, who was found to have underlying metastatic prostate cancer. Prostate cancer is uncommonly associated with DM. The patient tested positive for antitranscription intermediate family-1 (anti-TIF-1, also known as anti-p155/410) antibodies, which are linked to malignancy-associated DM in adults and are associated with dysphagia and more severe cutaneous findings.
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Affiliation(s)
| | - Samuel Z Maron
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Melissa J Ng
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alaina J Kessler
- Department of Hematology-Oncology, Mount Sinai Hospital, New York, NY; and
| | - Clare H Bryce
- Department of Pathology, Mount Sinai Hospital, New York, NY
| | - Vicki L Shanker
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephen N Scelsa
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
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3
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Cailleteau A, Touzeau C, Jamet B, Guimas V, Jouglar E, Supiot S. Cytokine release syndrome and tumor lysis syndrome in a multiple myeloma patient treated with palliative radiotherapy: A case report and review of the literature. Clin Transl Radiat Oncol 2021; 32:24-28. [PMID: 34816023 PMCID: PMC8591462 DOI: 10.1016/j.ctro.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/27/2022] Open
Abstract
We present the case of a 53-year-old woman treated with analgesic radiotherapy for a multiple myeloma bone lesion of the forearm. After a first fraction of 5 Gray (Gy), she presented with an acute respiratory syndrome with fever a few hours after the treatment. The same symptoms occurred after the second fraction 3 days later. The patient recovered quickly thanks to intravenous hydration and suspension of the radiotherapy. Biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. This is the second time in the literature that cytokine release syndrome has been described following radiotherapy. First, we synthesize TLS and radiotherapy to determine how radiotherapy could be a trigger associated with other well-known factors. Furthermore, we discuss radiotherapy and cytokine release syndrome. Summary We present the case of a woman treated with analgesic radiotherapy for a multiple myeloma bone lesion. Following the first and the second treatment fraction, the patient presented with an acute respiratory syndrome with fever and biological tests revealed a tumor lysis syndrome. We concluded that the clinical symptoms could be defined as cytokine release syndrome. Furthermore, we discuss how radiotherapy could be a trigger of cytokine release syndrome and tumor lysis syndrome in association with chemotherapy drugs.
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Affiliation(s)
- Axel Cailleteau
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Cyrille Touzeau
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Site de Recherche Intégrée sur le Cancer (SIRIC), ILIAD, Nantes, France
| | - Bastien Jamet
- Nuclear Medicine Department, University Hospital of Nantes, Nantes, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France.,Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), UMR 1232 Inserm - 6299 CNRS, Institut de Recherche en Santé de l'Université de Nantes, Nantes, France
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4
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Attinà G, Tepedino R, Ruggiero A. Acute Tumor Lysis Syndrome: A Metabolic Emergency in Cancer Patients. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2021; 14:1721-1729. [DOI: 10.13005/bpj/2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Tumor lysis syndrome (TLS) can be a life-threatening complication that occurs following the onset of chemotherapy treatment, most commonly in association with high-grade lymphoproliferative pathologies such as acute lymphoblastic leukemia and Burkitt lymphoma. The massive cell lysis caused by cytotoxic therapy leads to the rapid release in the blood of intracelullary products and the onset of severe metabolic and electrolytic complications (hyperkalemia, hyperphosphatemia, hypocalcemia and hyperuricemia) upto the acute renal failure. This article describes the incidence and pathophysiological basis of TLS, focusing on the new therapeutic strategies implemented over the last few years, especially with regard to the treatment of hyperuricemia. In particular, it highlights the characteristics of a recent drug, Rasburicase, as a safe and effective alternative, compared to traditional allopurinol therapy, for prophylaxis and treatment of children with hyperuricemia induced by chemotherapy.
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Affiliation(s)
- Giorgio Attinà
- 1Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | | | - Antonio Ruggiero
- 1Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
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5
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Diffuse Large B-Cell Lymphoma During Third-Trimester Pregnancy and Lactation. Obstet Gynecol 2020; 136:195-196. [PMID: 32590710 DOI: 10.1097/aog.0000000000003973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Abstract
BACKGROUND Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma affecting pregnancy. These tumors may be aggressive and rapidly growing in pregnancy. Management is based on the balance of risks and benefits to both the pregnant patient and the fetus. CASE We present a case of diffuse large B-cell lymphoma diagnosed in the third trimester of pregnancy. The patient underwent labor induction at 34 weeks of gestation, started a standard chemotherapy protocol postpartum, and breastfed following a timed lactation protocol. CONCLUSION Management of lymphoma during pregnancy highlights the need to consider all aspects of proposed oncologic and obstetric care as well as neonatal risks. Considerations highlighted in this case include staging methods, administration of antenatal steroids, timing of delivery, and lactation during chemotherapy.
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7
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Fan FS, Yang CF. Chemotherapy-induced necrotising tumour lysis and perforation of a huge gastric cancer simulating emphysematous pancreatitis. Ecancermedicalscience 2020; 14:1054. [PMID: 32582369 PMCID: PMC7302892 DOI: 10.3332/ecancer.2020.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
A 56-year-old man was diagnosed to have a huge gastric cancer extending from the lesser curvature of the stomach to the pancreas with multiple hepatic and peritoneal metastases. Two days after completing chemotherapy with cisplatin plus high dose leucovorin and fluorouracil, drastic necrotising tumour lysis led to gastric perforation and septic shock most likely due to bacterial peritonitis. The image of tumour lysis looked like an emphysematous pancreatitis. Afterwards, immunohistochemical study of the tumour specimen confirmed moderate positivity of dihydropyrimidine dehydrogenase and absence of Bcl-2 expression. The incomplete expression of dihydropyrimidine dehydrogenase and total deficiency of Bcl-2 are considered to be the main underlying causes of such extraordinary chemosensitivity and so severe a tumour lysis phenomenon. Pre-emptive intensive survey of possible biomarkers of chemosensitivity is thus highly recommended upon treating a massive gastric cancer.
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Affiliation(s)
- Frank S Fan
- Section of Haematology and Oncology, Department of Medicine, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-8123-6941
| | - Chung-Fan Yang
- Department of Pathology, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-7366-4380
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8
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Findakly D, Luther RD, Wang J. Tumor Lysis Syndrome in Solid Tumors: A Comprehensive Literature Review, New Insights, and Novel Strategies to Improve Outcomes. Cureus 2020; 12:e8355. [PMID: 32494548 PMCID: PMC7263728 DOI: 10.7759/cureus.8355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening oncological condition that is typically characterized by metabolic derangements that are often labeled as an acute kidney injury. The recent advancement in cancer treatment has led to the mounting rate of TLS in solid tumors that were previously rarely linked to this complication. Given that its prognosis is dismal, it is essential to increase recognition of this condition by describing more sensitive markers. Currently, the management of TLS is mainly supportive due to the lack of specific therapy targeting its specific pathology. This review aims to summarize the most recent literature on the underlying mechanism of TLS and the potential implications for novel TLS therapy.
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Affiliation(s)
- Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | | | - Jue Wang
- Genitourinary Oncology, Creighton University School of Medicine/University of Arizona Cancer Center at Dignity Health, Phoenix, USA
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9
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Hyperuricemia might be an early manifestation of undiagnosed adult leukemia in a population-based cohort study. Biomedicine (Taipei) 2020; 10:40-44. [PMID: 33854912 PMCID: PMC7608843 DOI: 10.37796/2211-8039.1004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
Background/objective No published population-based study investigates the association between hyperuricemia and undiagnosed adult leukemia in Taiwan. The aim of the study was to investigate whether hyperuricemia might be an early manifestation of undiagnosed adult leukemia in Taiwan. Methods A population-based cohort study was conducted to analyze the database of the Taiwan National Health Insurance Program. There were 47708 subjects aged 20 to 84 years with newly diagnosed hyperuricemia as the hyperuricemia group from 2000 to 2013, and 190832 randomly selected subjects without hyperuricemia as the non-hyperuricemia group. The hyperuricemia group and the non-hyperuricemia group were followed for one year to estimate the incidence of new diagnosis of leukemia. Results The overall incidence of leukemia was 1.32-fold higher in the hyperuricemia group than the non-hyperuricemia group (0.74 versus 0.55 per 10000 person-months, 95% confidence interval 1.28-1.37). The incidence rate ratio of leukemia was statistically higher in the first 3 months of hyperuricemia diagnosis (incidence rate ratio 4.05). Conclusion Adults with hyperuricemia have a higher incidence of being diagnosed with leukemia than those without hyperuricemia. Hyperuricemia might be an early manifestation of undiagnosed adult leukemia. Clinicians should check the complete blood count with differential to detect the possibility of leukemia when adults present with hyperuricemia.
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10
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Yavorkovsky LL, Jing W, Baker R. An upsurge of the serum free light chains as a possible missing link in tumour lysis syndrome in multiple myeloma. Br J Haematol 2019; 188:732-735. [PMID: 31573682 DOI: 10.1111/bjh.16231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Multiple myeloma (MM) is a slow-growing malignancy characterized by a low proliferation rate of plasma cells and a relatively rare incidence of tumour lysis syndrome (TLS). Three myeloma patients developed TLS following cytotoxic therapy (two after radiation treatment) that was associated with an abrupt increase of serum free light chains (FLC). All three patients demonstrated extramedullary plasmacytomas that exhibited aggressive features compared to the original myeloma. The findings suggested that an abrupt liberation (rather than slow secretion) of FLC from myeloma cells may trigger a fulminant cast nephropathy and present an unrecognized risk factor and potentially aggravating component of TLS.
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Affiliation(s)
| | - Wen Jing
- Pathology/Immunohistopathology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Robin Baker
- Pathology/Immunohistopathology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
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11
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Pindak D, Rejlekova K, Tomas M, Aziri R, Rovenska E, Puskacova J, Mego M. Intraoperative tumor lysis syndrome in a giant teratoma: a case report. BMC Surg 2019; 19:62. [PMID: 31200669 PMCID: PMC6570972 DOI: 10.1186/s12893-019-0526-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/31/2019] [Indexed: 11/29/2022] Open
Abstract
Background Tumor lysis syndrome is an unusual metabolic emergency in solid tumors. Perioperative occurrence of this syndrome is extremely rare but may have fatal consequences if not detected and treated on time. Case report We report a 19-year patient with testicular germ cell tumor after first line chemotherapy with giant growing teratoma syndrome in retroperitoneum. He underwent radical resection, however, perioperatively, a fatal case of heart failure due to unrecognized intraoperative tumor lysis syndrome developed. Conclusion Surgeons, anesthesiologists and oncologists should be aware of this complication in order to be prepared for such an emergency.
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Affiliation(s)
- Daniel Pindak
- Department of Surgical Oncology, National Cancer Institute Bratislava, Bratislava, Slovakia.,Department of Surgical Oncology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Katarina Rejlekova
- 2nd Department of Oncology Faculty of Medicine, Comenius University, Bratislava, Slovakia. .,Department of Oncology, National Cancer Institute Bratislava, Klenova 1, 833 10, Bratislava, Slovakia.
| | - Miroslav Tomas
- Department of Surgical Oncology, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Ramadan Aziri
- Department of Surgical Oncology, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Eva Rovenska
- Department of Surgical Oncology, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Judita Puskacova
- Department of Pediatric Hematology and Oncology, Comenius University Children's Hospital, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Department of Oncology, National Cancer Institute Bratislava, Klenova 1, 833 10, Bratislava, Slovakia
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12
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Spontaneous tumor lysis syndrome in a patient with newly diagnosed metastatic colonic adenocarcinoma. CAN J EMERG MED 2017; 20:S41-S43. [PMID: 28893339 DOI: 10.1017/cem.2017.378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute tumor lysis syndrome in the absence of cytotoxic therapy is an uncommon event but has been reported with hematologic malignancies. The case described below illustrates spontaneous tumor lysis syndrome in the context of a rapidly proliferating metastatic colonic adenocarcinoma. Clinicians should consider ordering phosphate, uric acid, and calcium when assessing patients with recently diagnosed or suspected malignancy.
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13
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A Clinical and Economic Comparison of Rasburicase and Allopurinol in the Treatment of Patients With Clinical or Laboratory Tumor Lysis Syndrome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:173-178. [DOI: 10.1016/j.clml.2016.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/10/2016] [Accepted: 11/10/2016] [Indexed: 11/21/2022]
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14
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Stuart S, Auten J. A rare seizure: Tumor lysis syndrome after radiation therapy of a solid tumor. Am J Emerg Med 2017; 35:941.e3-941.e4. [PMID: 28132791 DOI: 10.1016/j.ajem.2017.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an uncommon but life threatening condition seen in oncology patients. Due to its underlying pathophysiology, it is classically associated with hematologic malignancies following chemotherapeutic treatment. In this article, we present a case of TLS in the setting of two rare features: a solid tumor malignancy and the absence of recent chemotherapy. We briefly review risk factors and the diagnosis of this potentially fatal but treatable condition.
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Affiliation(s)
- Sean Stuart
- Emergency Department, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, United States.
| | - Jonathan Auten
- Emergency Department, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, United States.
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15
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Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:135. [PMID: 27301374 PMCID: PMC4908773 DOI: 10.1186/s13054-016-1314-5] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis. Methods A systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics. Results The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis. Conclusion Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
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16
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Dhar M, Prakash S, Pandey V, Pai VK. Intraoperative tumor lysis syndrome in a child with Wilms' tumor. Anesth Essays Res 2016; 10:145-7. [PMID: 26957712 PMCID: PMC4767093 DOI: 10.4103/0259-1162.171446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Tumor lysis syndrome in an onco-metabolic emergency resulting from massive lysis of rapidly proliferating malignant cells seen commonly in patients with hematological malignancies such as acute lymphocytic leukemia and Burkitt's lymphoma and is quite rare in solid tumors. Spontaneous development of tumor lysis has been described among other trigger factors such as corticosteroid therapy, anesthesia, tumor manipulation during surgery and pyrexia. We describe such a case in a 5-year-old boy posted for excision and staging of a massive Wilms' tumor who developed a hyperkalemic cardiac arrest during the procedure and its subsequent intraoperative and postoperative management. Intraoperative cardiac arrest is a stressful situation for both the anesthesiologist and the surgeon, more so when it involves a child. The aim of this report is to make the anesthesiologist aware of the possibility and occurrence of such a phenomenon in children and be adequately prepared for such an emergency.
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Affiliation(s)
- Mridul Dhar
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shashi Prakash
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vishal Krishna Pai
- Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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17
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Takai M, Yamauchi T, Matsuda Y, Tai K, Ikegaya S, Kishi S, Urasaki Y, Yoshida A, Iwasaki H, Ueda T. Reduced administration of rasburicase for tumor lysis syndrome: A single-institution experience. Oncol Lett 2015; 9:2119-2125. [PMID: 26137024 DOI: 10.3892/ol.2015.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/29/2015] [Indexed: 11/06/2022] Open
Abstract
In the present study, the dosage and duration of rasburicase administration were retrospectively evaluated for the ability to control the serum uric acid (S-UA) level in 13 patients diagnosed with hematological malignancies and tumor lysis syndrome (TLS), or those at risk of developing TLS, at the University of Fukui Hospital. At the time of diagnosis, seven patients already exhibited laboratory TLS, and three demonstrated clinical TLS. All patients received rasburicase in addition to chemotherapy agents. The median dose was 0.19 mg/kg (range, 0.13-0.25 mg/kg), and the median duration was four days (range, 1-7 days). Six patients sequentially received a xanthine oxidase inhibitor, allopurinol or febuxostat. The primary estimate was the normalization of the S-UA level at the end of rasburicase treatment and on treatment day seven. The average S-UA level prior to treatment was 10.4±4.5 mg/dl (mean ±standard deviation), and 11 out of 13 patients demonstrated a S-UA level >7 mg/dl. The S-UA level at the end of rasburicase administration was 0.5±1.5 mg/dl and the S-UA level at day seven was 1.4±1.5 mg/dl. All the patients achieved normalization of the S-UA level. On day seven subsequent to the initiation of treatment, the patients receiving rasburicase for a maximum of three days exhibited an S-UA level of 1.9±1.8 mg/dl, while the patients receiving rasburicase for longer than three days demonstrated an S-UA level of 1.0±1.3 mg/dl (P=0.20; Mann-Whitney test). The administration of 0.13 mg/kg and 0.22 mg/kg resulted in comparable UA level reductions. The administration of allopurinol or febuxostat following rasburicase administration suppressed the re-increase in S-UA level. Therefore, it was concluded that reduced administration of rasburicase successfully controlled the S-UA level in TLS.
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Affiliation(s)
- Mihoko Takai
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Yasufumi Matsuda
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Katsunori Tai
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Satoshi Ikegaya
- Division of Infection Control, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Shinji Kishi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Yoshimasa Urasaki
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Akira Yoshida
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Takanori Ueda
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui 910-1193, Japan
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Uveal Melanoma Metastatic to the Liver: Chemoembolization With 1,3-Bis-(2-Chloroethyl)-1-Nitrosourea. AJR Am J Roentgenol 2015; 205:429-33. [PMID: 25905562 DOI: 10.2214/ajr.14.14001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate whether chemoembolization with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) is a safe and effective treatment for bulky uveal melanoma liver metastasis. MATERIALS AND METHODS Over a 7-year period, 63 treatment-naïve patients presented with uveal melanoma metastasis replacing 50% or more of the normal liver parenchyma. Patients with Eastern Cooperative Oncology Group 0-2 performance status, no extensive extrahepatic metastases, and adequate liver and renal function were treated with BCNU (200 mg) chemoembolization. Pretreatment tumor burdens were classified by MRI as 50-75% and more than 75%. Lactate dehydrogenase (LDH) levels were divided into less than or equal to 500 and more than 500 IU/L (i.e., more than twice the normal level). Treatment toxicity was assessed using Common Terminology Criteria for Adverse Events (version 4.0). CT and MRI were used to determine best radiologic response (Response Evaluation Criteria in Solid Tumors). Overall survival (OS) and progression-free survival (PFS) were compared with tumor burden and LDH levels. RESULTS Fifty patients (31 men; mean age, 59.1 years; range, 30-88 years) met the inclusion criteria. A total of 271 chemoembolization procedures were performed. Grade 3 thrombocytopenia occurred in two patients, grade 3 hyperbilirubinemia (n = 2) was attributed to disease progression, and asymptomatic grade 4 transaminitis occurred after 16 treatments. Best radiologic response was as follows: partial response, n = 3; stable disease, n = 33; and disease progression, n = 12 (no follow-up imaging, n = 2). The median OS was 7.1 months (range, 1.2-32.3 months), and the median PFS was 5.0 months (range, 1.1-32.3 months). Eleven patients (22%) survived longer than 12 months (range, 12.2-32.3) with one patient alive at follow-up. Tumor burden and LDH levels showed no statistically significant effect on OS (p = 0.20 and p = 0.14, respectively) or PFS (p = 0.10 and p = 0.34, respectively). CONCLUSION BCNU chemoembolization should be considered as a treatment option for patients with bulky uveal melanoma hepatic metastases.
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Kim JO, Jun DW, Tae HJ, Lee KN, Lee HL, Lee OY, Choi HS, Yoon BC, Hahm JS. Low-dose steroid-induced tumor lysis syndrome in a hepatocellular carcinoma patient. Clin Mol Hepatol 2015; 21:85-8. [PMID: 25834806 PMCID: PMC4379202 DOI: 10.3350/cmh.2015.21.1.85] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/05/2022] Open
Abstract
Tumor lysis syndrome is rare in hepatocellular carcinoma (HCC), but it has been reported more frequently recently in response to treatments such as transcatheter arterial chemoembolization (TACE), radiofrequency thermal ablation (RFTA), and sorafenib. Tumor lysis syndrome induced by low-dose steroid appears to be very unusual in HCC. We report a patient with hepatitis-C-related liver cirrhosis and HCC in whom tumor lysis syndrome occurred due to low-dose steroid (10 mg of prednisolone). The patient was a 90-year-old male who presented at the emergency room of our hospital with general weakness and poor oral intake. He had started to take prednisolone to treat adrenal insufficiency 2 days previously. Laboratory results revealed hyperuricemia, hyperphosphatemia, and increased creatinine. These abnormalities fulfilled the criteria in the Cairo-Bishop definition of tumor lysis syndrome. Although the patient received adequate hydration, severe metabolic acidosis and acute kidney injury progressed unabated. He finally developed multiple organ failure, and died 3 days after admission. This was a case of tumor lysis syndrome caused by administration of low-dose steroid in a patient with HCC.
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Affiliation(s)
- Jin Ok Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye Jin Tae
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kang Nyeong Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hang Lak Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung Chul Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joon Soo Hahm
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Elmore SA, Cora MC, Gruebbel MM, Hayes SA, Hoane JS, Koizumi H, Peters R, Rosol TJ, Singh BP, Szabo KA. Proceedings of the 2014 National Toxicology Program Satellite Symposium. Toxicol Pathol 2014; 43:10-40. [PMID: 25385331 DOI: 10.1177/0192623314555526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The 2014 annual National Toxicology Program (NTP) Satellite Symposium, entitled "Pathology Potpourri" was held in Washington, D.C., in advance of the Society of Toxicologic Pathology's 33rd annual meeting. The goal of this annual NTP Symposium is to present current diagnostic pathology or nomenclature issues to the toxicologic pathology community. This article presents summaries of the speakers' presentations, including diagnostic or nomenclature issues that were presented, along with select images that were used for audience voting and discussion. Some lesions and topics covered during the symposium included a pulmonary mucinous adenocarcinoma in a male B6C3F1 mouse; plexiform vasculopathy in Wistar Han (Crl:WI[Han]) rats; staging of the estrous cycle in rats and mice; peri-islet fibrosis, hemorrhage, lobular atrophy and inflammation in male Sprague-Dawley (SD) rats; retinal dysplasia in Crl:WI[Han] rats and B6C3F1 mice; multicentric lymphoma with intravascular microemboli and tumor lysis syndrome, and 2 cases of myopathy and vascular anomaly in Tg.rasH2 mice; benign thymomas in Crl:WI[Han] rats; angiomatous lesions in the mesenteric lymph nodes of Crl:WI[Han] rats; an unusual foveal lesion in a cynomolgous monkey; and finally a series of nomenclatures challenges from the endocrine International Harmonization of Nomenclature and Diagnostic Criteria (INHAND) Organ Working Group (OWG).
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Affiliation(s)
- Susan A Elmore
- National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Michelle C Cora
- National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Margarita M Gruebbel
- Experimental Pathology Laboratories, Inc., Research Triangle Park, North Carolina, USA
| | - Schantel A Hayes
- Charles River Laboratories, Pathology Associates, Durham, North Carolina, USA
| | - Jessica S Hoane
- Charles River Laboratories, Pathology Associates, Durham, North Carolina, USA
| | | | - Rachel Peters
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | | | - Bhanu P Singh
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Kathleen A Szabo
- Charles River Laboratories, Pathology Associates, Durham, North Carolina, USA
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Abstract
Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.
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Affiliation(s)
- P Manghat
- Department of Chemical Pathology, Darent Valley Hospital, Dartford, UK
| | - R Sodi
- Department of Biochemistry, NHS Lanarkshire, East Kilbride, UK
| | - R Swaminathan
- Department of Chemical Pathology, St. Thomas Hospital, London, UK
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Takai M, Yamauchi T, Fujita K, Lee S, Ookura M, Kishi S, Urasaki Y, Yoshida A, Iwasaki H, Ueda T. Controlling serum uric acid using febuxostat in cancer patients at risk of tumor lysis syndrome. Oncol Lett 2014; 8:1523-1527. [PMID: 25202361 PMCID: PMC4156226 DOI: 10.3892/ol.2014.2394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/24/2014] [Indexed: 11/05/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening oncological emergency, in which control of serum uric acid (S-UA) levels is important. S-UA-lowering efficacy of a new xanthine oxidase inhibitor, febuxostat, was retrospectively evaluated in seven patients with hematological malignancies who were at an intermediate risk of developing TLS. A 10-mg dose of febuxostat was initiated and chemotherapy was started within 24 h of administering the first dose of febuxostat. Febuxostat was continued until at least day 7 of chemotherapy treatment. The UA-lowering treatment was considered effective if febuxostat reduced S-UA levels to ≤7.5 mg/dl by day 5. The mean S-UA level at base line was 6.4±2.6 mg/dl and, on day 5, the mean S-UA level was 4.7±1.8 mg/dl. All the patients achieved S-UA levels ≤7.5 mg/dl. Serum creatinine levels decreased from 0.93±0.25 to 0.85±0.25 mg/dl. The estimated glomerular filtration rate values increased from 69.7±24.5 to 76.9±26.2 ml/min. No adverse reactions were noted during the study period and no patients experienced progressive TLS. Successful control of S-UA and improved renal function were obtained in response to febuxostat treatment in cancer patients at a risk of TLS.
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Affiliation(s)
- Mihoko Takai
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Kei Fujita
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Shin Lee
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Miyuki Ookura
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Shinji Kishi
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Yoshimasa Urasaki
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Akira Yoshida
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
| | - Takanori Ueda
- Department of Hematology and Oncology, University of Fukui, Matsuoka, Eiheiji, Fukui 910-1193, Japan
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Sondhi V, Sharma A, Taneja M, Arora B, Banavali SD. L-asparginase administration reduces white blood cell count and prevents tumor lysis syndrome in children with hyperleukocytic acute lymphoblastic leukemia. Acta Haematol 2014; 133:6-9. [PMID: 24968963 DOI: 10.1159/000358115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of hyperleukocytosis currently involves intensive supportive care for preventing tumor lysis syndrome (TLS)-associated metabolic abnormalities as well as cytoreduction procedures to reduce the white blood cell (WBC) count. These procedures are often equipment-intensive and may not be practised in developing countries with limited resources. Hence, it is not clear what would be the most effective strategy to manage hyperleukocytosis and prevent TLS. PROCEDURE All children ≤12 years, diagnosed with acute lymphoblastic leukemia (ALL) and hyperleukocytosis (WBC count >100 × 10(9)/l) were administered L-asparginase (L-asp, 6,000 U/m(2), i.m.) along with standard supportive care consisting of hydration, oral allopurinol administration and alkalization. The complete blood counts and biochemical parameters were monitored for 72 h. After 48 h, if the WBC count was >100 × 10(9)/l, a repeat dose of L-asp was administered. RESULTS Twenty-one children (9 boys and 12 girls) with hyperleukocytic ALL were treated with L-asp. The median age of the children was 5.3 years (range 2-11 years). The median initial WBC count was 249 × 10(9)/l (range 151-476 × 10(9)/l). Twenty children received only one dose of L-asp. The mean reduction in WBC count achieved by treatment was 15.7, 42.0, 61.0, 76.4, 85.5 and 90.8% at 12, 24, 36, 48, 60 and 72 h, respectively. None of the patients developed TLS. CONCLUSIONS Chemical cytoreduction by administering L-asp is an effective means of managing hyperleukocytosis and preventing TLS.
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Affiliation(s)
- Vishal Sondhi
- Department of Pediatrics, Armed Forces Medical College, Pune, India
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Azim HA, Bahr SA, Kamal NS, Koura MA, Tolba R, Gad HA, Morsy A, Attia HM, Iskander I, Hammad A, Hemed MF, Abdallah MF, Sadek KA, Taha AH. One for the road! A study to assess the efficacy of single low-dose regimen of rasburicase in controlling hyperuricaemia in patients with tumour lysis syndrome due to haematological malignancies. Ecancermedicalscience 2013; 7:378. [PMID: 24324529 PMCID: PMC3855003 DOI: 10.3332/ecancer.2013.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Indexed: 11/20/2022] Open
Abstract
We conducted a retrospective audit of six patients with various haematological malignancies (two acute lymphoblastic leukaemia, one acute myeloid leukaemia, and three non-Hodgkin lymphoma); these patients were eligible to receive rasburicase, being at high risk of development of tumour lysis syndrome (TLS). They received a fixed single low-dose regimen of rasburicase (7.5 mg) mainly due to financial restriction, as patients were not supported by the National Health Service and did not have health insurance. We compared uric acid, creatinine levels, and electrolytes (i.e. phosphate, potassium, and calcium) before and after rasburicase administration and also assessed the need for renal replacement therapy after treatment. All six patients had a significant reduction in uric acid levels on the first day, achieving a response rate of 100% (p = 0.008994); creatinine, phosphate, and potassium were reduced significantly as well, with the p values of 0.0439, 0.014326, and 0.002008, respectively; only one patient needed renal replacement therapy in the form of haemodialysis, due to concerns about hyperphosphataemia. Financial difficulties faced either because patients lacked insurance or because of the restricted National Health Service budget in Egypt have resulted in the unavailability of certain modalities of treatment in cancer care and the need to consider more economic yet efficient approaches. Our experience suggests that a single low-dose rasburicase injection (7.5 mg) is an efficient and cost-effective method to control hyperuricaemia in patients with a high risk of developing TLS when compared with the more expensive and extended standard regimen and doses recommended.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt ; Clinical Oncology and Bone Marrow Transplantation Unit, Manial Specialized University Hospital, Cairo University, Cairo, Egypt
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Ye Z, Palazzo JP, Lin L, Lai Y, Guiles F, Myers RE, Han J, Xing J, Yang H. Postoperative hyperphosphatemia significantly associates with adverse survival in colorectal cancer patients. J Gastroenterol Hepatol 2013; 28:1469-75. [PMID: 23611210 PMCID: PMC3775915 DOI: 10.1111/jgh.12237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Hyperphosphatemia has been implicated in the development and treatment of various cancers. However, whether it can be used as a direct prognostic marker of colorectal cancer (CRC) has remained unexplored. Given new insights into the importance of hyperphosphatemia in CRC, we sought to evaluate the association of hyperphosphatemia with the clinical outcomes of this disease. METHODS In a retrospective analysis of a well-characterized clinic-based cohort with 1241 CRC patients, we assessed the association of postoperative hyperphosphatemia with patient overall survival. RESULTS Postoperative hyperphosphatemia measured within the first month after surgery was significantly associated with CRC survival. Compared to patients with a normal phosphate level, those with hyperphosphatemia exhibited a significant unfavorable overall survival with a hazard ratio (HR) of 1.84 (95% confidence interval [CI] 1.49-2.29, P = 2.6 × 10(-8) (log-rank P = 1.2 × 10(-7) ). Stratified analyses indicated the association was more pronounced in patients with colon (HR = 2.00, 95% CI 1.57-2.56, P = 3.17 × 10(-8) ) but not rectal cancer (HR = 0.96, 95% CI 0.58-1.59, P = 0.889) (P interaction = 0.023), as well as in those not receiving chemotherapy (HR = 2.15, 95% CI 1.59-2.90, P = 6.2 × 10(-7) ) but not in those receiving chemotherapy (HR = 1.30, 95% CI 0.92-1.82, P = 0.136) (P interaction = 0.012). Flexible parametric survival model demonstrated that the increased risk for death conferred by postoperative hyperphosphatemia persisted over 150 months after surgery. CONCLUSION Our data indicated that postoperative hyperphosphatemia might be used as a prognostic marker of CRC patients after surgery. Since phosphate level is routinely tested in clinics, it may be incorporated into clinical models to predict CRC survival.
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Affiliation(s)
- Zhong Ye
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Juan P. Palazzo
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Liz Lin
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Yinzhi Lai
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Fran Guiles
- Oncology Data Service, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jin Han
- Department of Pharmacy, Rush University Medical Center, Chicago, IL 60612
| | - Jinliang Xing
- Experimental Teaching Center, Fourth Military Medical University, Xi’an, 710032, China
| | - Hushan Yang
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA,Correspondence to: Hushan Yang, PhD, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA. Tel: 215-503-6521; Fax: 267-336-0247;
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